MEDICARE: HEATHER MARIE RUSSELL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP70026937	WA
2	163W00000X	Registered Nurse	RN60774952	WA
3	363LP2300X	Primary Care Nurse Practitioner	AP70026937	WA

General Provider Information

NPI Number	:	1568939981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE RUSSELL ARNP

Provider Business Mailing Address
First Line	:	2210 HEWITT AVE STE 203
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98201-3767
Country	:	US
Telephone Number	:	425-689-1212
Fax Number	:	425-276-8202

Provider Business Practice Location Address
First Line	:	2210 HEWITT AVE STE 203
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98201-3767
Country	:	US
Telephone Number	:	425-689-1212
Fax Number	:	425-276-8202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	12/02/2025

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