Provider Demographics
NPI:1851776835
Name:HUFFMAN, RUSSELL TODD (RN, ARNP)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:TODD
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2485 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2151
Mailing Address - Country:US
Mailing Address - Phone:503-363-8047
Mailing Address - Fax:503-363-6571
Practice Address - Street 1:1601 E 4TH PLAIN BLVD
Practice Address - Street 2:BLDG 17 STE B222
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-397-8484
Practice Address - Fax:360-397-8494
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606694NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health