Provider Demographics
NPI:1578273066
Name:RUSSO, SAMANTHA (CRM)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1482
Mailing Address - Country:US
Mailing Address - Phone:541-388-8459
Mailing Address - Fax:
Practice Address - Street 1:466 NW 3RD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-388-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist