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Justin Jake Russell, LMP
Specialist in Leavenworth, Washington
NPI 1003092594

Justin Jake Russell is a Specialist based in Leavenworth, WA. Justin Jake Russell practices in Leavenworth, WA and has the professional credentials of LMP. The NPI Number for Justin Jake Russell is 1003092594 and holds a License No. MA00024875 (Washington).

The current practice location address for Justin Jake Russell is 22470 Humphrey Dr, Leavenworth, WA and can be reached out via phone at 253-389-7510. You can also correspond with Justin Jake Russell through the mailing address at PO BOX 475, LEAVENWORTH, WA - 98826-0475 (mailing address contact number: 253-389-7510).

Location: 22470 Humphrey Dr, Leavenworth, WA, 98826-0475
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1003092594
Provider Name
Justin Jake Russell
Credential
LMP
Provider Entity Type
Individual
Gender
Male
Address
22470 Humphrey Dr, Leavenworth, WA, 98826-0475
Phone Number
253-389-7510
Fax Number
Provider Enumeration Date
01/14/2008
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
22470 Humphrey Dr
City
Leavenworth
State
Washington
Zip
98826-9240
Phone Number
253-389-7510
Fax Number
person
Provider Business Mailing Address Details
Address
22470 Humphrey Dr
City
Leavenworth
State
Washington
Zip
98826-9240
Phone Number
253-389-7510
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
MA00024875 (Washington)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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