Provider Demographics
NPI:1861778649
Name:RUSSO-DIGEORGE, JAMIE LEIGH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEIGH
Last Name:RUSSO-DIGEORGE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:11511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:425-502-3000
Practice Address - Fax:844-620-1839
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2024-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAPA.200449363A00000X
WAPA60278090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant