Provider Demographics
NPI:1790892024
Name:RUSSELL, DAWN R (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:SUITE #420
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-899-6400
Mailing Address - Fax:425-899-4490
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:SUITE #420
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-6400
Practice Address - Fax:425-899-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81225207VX0000X
WAMD39840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1113158Medicaid
WAG8907943Medicare PIN
WA1113158Medicaid
WAG8853208Medicare PIN
WAH42363Medicare UPIN