NPI 1053733030

Russell B Boulware

Practitioner Case Manager/Care Coordinator Albany, OR

Practice location

Address: 445 3rd Ave SW, Albany, OR 97321-2272
Phone: (541) 967-3866
Fax: (541) 812-8812
Mailing address: PO Box 100, Albany, OR 97321-0031

Registered specialties

Case Manager/Care Coordinator Primary

Other Service Providers Taxonomy 171M00000X

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Registry record

NPI: 1053733030
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Jan 2014
Record last updated: 10 Jan 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.