Individual provider · Type 1 NPI

Bethany Russotto, PA-C

Medical Physician Assistant · Portland, OR

NPI number 1447891353 Active

Practice location

3181 SW Sam Jackson Park Rd # PPV05
Portland, OR 97239-3098

Call (714) 449-7400 Map

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000XPA208945 (OR)
Physician Assistant 363A00000XNone listed
Student in an Organized Health Care Education/Training Program 390200000XNone listed
Medical Physician Assistant Primary 363AM0700XPA208945 (OR)

Medical Physician Assistant: Definition to come...

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About NPI 1447891353

Bethany Russotto, PA-C's National Provider Identifier is 1447891353, issued on Oct 2, 2019. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Jan 18, 2022.