Provider Demographics
NPI:1164850137
Name:RUSSELL, JENNIFER (DVM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-9142
Mailing Address - Country:US
Mailing Address - Phone:360-835-2184
Mailing Address - Fax:360-835-2186
Practice Address - Street 1:3501 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-9142
Practice Address - Country:US
Practice Address - Phone:360-835-2184
Practice Address - Fax:360-835-2186
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVT60410284174M00000X
OR5806174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian