IndividualActive
Jacqueline Russell, PMHNP-BC
NPI 1720673577 · Psychiatric/Mental Health Nurse Practitioner · Enterprise, OR
Provider details
- NPI number
- 1720673577
- Entity type
- Individual
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PMHNP-BC
- Sex
- Female
- Sole proprietor
- No
- License
- 10013334 (OR)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
606 Medical Pkwy
Enterprise, OR 97828-5140
Phone: (541) 426-4524
Fax: (541) 426-3035
Approximate (ZIP-level) locationGet directions
Mailing address
79571 Leap Ln
Wallowa, OR 97885-7107
Registry dates
- Enumerated
- 2021-03-03
- Last updated
- 2024-03-01
- Certified
- 2024-03-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.