Provider Demographics
NPI:1740379171
Name:SHAPIRO, RUSSELL STEPHEN (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:STEPHEN
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1172 HARBOR ISLE BLVD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1297
Mailing Address - Country:US
Mailing Address - Phone:541-331-9016
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6049
Practice Address - Country:US
Practice Address - Phone:541-273-1166
Practice Address - Fax:541-273-1822
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health