Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DO17341 | OR |
N | 207VX0000X | Obstetrician | DO17341 | OR |
NPI | 1417026659 |
---|---|
Provider Name | Mrs. Jill R Russell |
First Address | Hillsboro, OR 97123-8252 |
Second Address | Hillsboro, OR 97123-8252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 14/04/2016 |