MRS. DEBRA LYNN RUSSELL (NPI# 1760658462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760658462 |
| Entity Type | Individual |
| Full Name | MRS. DEBRA LYNN RUSSELL |
| Practice Address |
1507 Ne 122nd Ave Portland OR 97230 |
| Mailing Address |
1507 Ne 122nd Ave Portland OR 97230-1911 |
| Practice Telephone | 9718061436 |
| Mailing Telephone | 9718061436 |
| Mailing Fax Number | 5032308884 |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2018-06-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
| Y | 175T00000X | Peer Specialist | 0000311 | OR | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11035 Ne Sandy Blvd, Portland, OR 972202553 | 5032584200 | 5032308884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871836858 | Debra Lynn Russell | Nurse Practitioner | 24980 State Street, Po Drawer 519, Elberta, AL 36530 | 2013-03-28 |
| 1346526969 | Debra L Russell | Social Worker | 768 Potomac Ave, Buffalo, NY 14209-1025 | 2011-10-27 |
| 1366731606 | Debra P. Russell | Registered Nurse | 8401 Canyon Run Rd Ne, Albuquerque, NM 87111-6608 | 2011-04-06 |
| 1962779298 | Debra Lynne Russell | Registered Nurse | 20104 Nys Rt 3, Watertown, NY 13601-5560 | 2011-12-01 |
| 1376831941 | Debra Mae Russell | Nurse Practitioner | 102 Thomas Rd Ste 104, West Monroe, LA 71291-7365 | 2011-07-18 |
| 1902847528 | Debra Russell | Emergency Medicine | 18697 Bagley Rd, Middleburg Heights, OH 44130-3417 | 2006-06-08 |
| 1255304440 | Debra G Russell | Nurse Practitioner | 225 Physicians Park Ste 203, Poplar Bluff, MO 63901-3921 | 2006-02-09 |
| 1730159914 | Debra Kaye Russell | Radiology | 1001 Towson Ave, Fort Smith, AR 72901-4921 | 2006-01-23 |
| 1376522920 | Debra Russell | Registered Nurse | 1776 Sw Madison St, Portland, OR 97205-1715 | 2006-01-12 |
| Street Address |
1507 NE 122ND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821122391 | Christopher Wade Ferguson | Counselor | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2007-03-15 |
| 1003427915 | April Charee Jackson | Social Worker | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2020-08-13 |
| 1942849088 | Rachel Marie Adkins | Student in an Organized Health Care Education/Training Program | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2020-01-06 |
| 1144878562 | Amanda Louie | Counselor | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2019-08-28 |
| 1215583331 | Avery D'alessandro | Counselor | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2019-08-14 |
| 1750843561 | Jade Miller | Social Worker | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2019-04-01 |
| 1295292357 | Shelia Marie Danzuka | Counselor | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2019-02-25 |
| 1679042568 | Elizabeth Lebourveau | Counselor | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2018-11-20 |
| 1275008005 | Nicholas Michael Kramer | Counselor | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2018-10-08 |
| 1114407277 | Ryan Dicker | Social Worker | 1507 Ne 122nd Ave, Portland, OR 97230-1911 | 2018-08-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487255576 | Thomas Roy Hooks | Peer Specialist | 1221 Sw 11th Ave Apt 102, Portland, OR 97205-2143 | 2020-11-04 |
| 1538773155 | Mamie Nzigire Zagabe | Peer Specialist | 605 Se Cesar Estrada Chavez Blvd, Portland, OR 97214 | 2020-09-01 |
| 1245896307 | Anthony James Hardy | Peer Specialist | 10336 Ne Wygant St, Portland, OR 97220-3368 | 2019-05-14 |
| 1881155596 | Laray Jermaine Thomas | Peer Specialist | 11509 Se Stephens St, Portland, OR 97216-3660 | 2019-03-26 |
| 1932684248 | Dorothy Joanna Burton | Peer Specialist | 3716 Ne Martin Luther King Blvd, Portland, OR 97212-1111 | 2018-10-02 |
| 1750886255 | Steven Wade | Peer Specialist | 4512 Ne Portland Hwy, Portland, OR 97218-1363 | 2018-03-27 |
| 1669991212 | Kimberly Jaye Randall | Peer Specialist | 17214 Se Division St Ste 2, Portland, OR 97236-1282 | 2017-09-14 |
| 1689103897 | Walter Bulter | Peer Specialist | 5257 Ne Martin Luther King Jr Blvd Ste 202, Portland, OR 97211-3283 | 2017-06-09 |
| 1306373543 | Brenda Kay Mitchell | Peer Specialist | 10373 Ne Hancock St Ste 132, Portland, OR 97220-3873 | 2017-05-18 |
| 1760914493 | Changing Perceptions | Peer Specialist | 1720 Nw Lovejoy St # 329, Portland, OR 97209-2346 | 2017-03-31 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.