Provider Demographics
NPI:1316379985
Name:RUSSELL, JESSE COHEN (RN)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:COHEN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 195
Mailing Address - Street 2:
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241
Mailing Address - Country:US
Mailing Address - Phone:360-913-8774
Mailing Address - Fax:877-524-4405
Practice Address - Street 1:35620 321ST ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-9205
Practice Address - Country:US
Practice Address - Phone:360-913-8774
Practice Address - Fax:877-524-4405
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00098188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse