Provider Demographics
NPI:1619693892
Name:RUSSELL, LAUREN B (RN)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:B
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 1:600 SE MARION ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7058
Mailing Address - Country:US
Mailing Address - Phone:503-453-0412
Mailing Address - Fax:
Practice Address - Street 1:600 SE MARION ST UNIT 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7058
Practice Address - Country:US
Practice Address - Phone:503-453-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201241975RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201241975RNOtherOREGON STATE BOARD OF NURSING