Healthcare Provider Details

I. General information

NPI: 1568939981
Provider Name (Legal Business Name): HEATHER MARIE RUSSELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARIE JORDON ARNP

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 HEWITT AVE STE 203
EVERETT WA
98201-3767
US

IV. Provider business mailing address

2210 HEWITT AVE STE 203
EVERETT WA
98201-3767
US

V. Phone/Fax

Practice location:
  • Phone: 425-689-1212
  • Fax: 425-276-8202
Mailing address:
  • Phone: 425-689-1212
  • Fax: 425-276-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70026937
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60774952
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP70026937
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: