Healthcare Provider Details

I. General information

NPI: 1851776835
Provider Name (Legal Business Name): RUSSELL TODD HUFFMAN RN, ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD BLDG 17 STE B222
VANCOUVER WA
98661-3753
US

IV. Provider business mailing address

2485 12TH ST SE
SALEM OR
97302-2151
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8484
  • Fax: 360-397-8494
Mailing address:
  • Phone: 503-363-8047
  • Fax: 503-363-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201606694NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: