Russell R. Amaru, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10003509 Issued in WA

Practice address

2321 W Dayton Airport Rd
Shelton, WA 98584-6319

Phone

(360) 427-4596

Fax

(360) 427-4654

NPI assigned

Jan 4, 2010

Last updated

Aug 2, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280707200000",
    "number": "1942530647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3357A SIMMONS MILL CT. SW",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985127811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 W DAYTON AIRPORT RD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985846319",
            "telephone_number": "360-427-4596",
            "fax_number": "360-427-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMARU",
        "first_name": "RUSSELL",
        "middle_name": "R.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-04",
        "last_updated": "2010-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Allen
• Devin Ray Allen, AAC
• Jacinda Violetann Allen
• Swilenn Alexandra Almendarez, MA, LMHCA, MHP
• Rehana Amani
• Rhonda Ambrose
• American Oncology Partners, P.a.
• American Oncology Partners, P.a. (Vista Oncology)
• Anchored Counseling and Treatment Services PLLC
• Charles W Anderegg, PAC

• Medical Physician Assistant in Shelton, WA
• Providers in Shelton, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; 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.