JOHN MICHAEL RUSSELL

PORTLAND, OR
NPI1801804935
Professional NameJACK RUSSELL
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner Psychiatric/Mental Health
Enumeration Date2006-08-04
Last Update Date2007-07-26
Business Address
JOHN MICHAEL RUSSELL PMHNP
12732 SE STARK ST
PORTLAND, OR 97233-1539
Phone number: 503-514-1264
Mailing Address
JOHN MICHAEL RUSSELL PMHNP
12732 SE STARK ST
PORTLAND, OR 97233-1539
Phone number:
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