Provider Demographics
NPI:1104561836
Name:BRIGGS, RUSSELL (NP)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 26TH STREET CT W APT 120
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-8552
Mailing Address - Country:US
Mailing Address - Phone:608-212-6000
Mailing Address - Fax:
Practice Address - Street 1:10740 MERIDIAN AVE N STE 110
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9010
Practice Address - Country:US
Practice Address - Phone:425-578-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081133363LP0808X
WAAP61657332363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI231757-30OtherSTATE LICENSE
WAAP61657332OtherNP LICENSE
TX1081133OtherNP LICENSE