Theresa A Russell, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

91000286 Issued in OR

Practice address

406 NE 1St St
Enterprise, OR 97828-1168

Phone

(541) 426-4502

Fax

(541) 426-6403

NPI assigned

Aug 23, 2005

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Winding Waters Clinic PC

  • Rural Health Clinic/Center
  • Enterprise, OR
  • NPI 1053304394
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 13, 2013.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386892800000",
    "number": "1629061981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 NE 1ST ST",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281168",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 NE 1ST ST",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281168",
            "telephone_number": "541-426-4502",
            "fax_number": "541-426-6403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "THERESA",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-23",
        "last_updated": "2013-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "91000286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5966011",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "J054905",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "276716",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "500008058",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Rodgers
• Chelsee Jane Rohan, LPSC
• Kenneth D Rose, M.D.
• Kristen Ruckdashel
• Jacqueline Marie Russell, PMHNP-BC
• Margaret J Rystrom, RN, CNL
• Safeway Inc
• Koreen Marie Sanders, RPH
• Amanda Savage, LMT
• Angelina Schaeffer, RDH

• All providers in Enterprise, OR
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.