Individual
JACOB NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
890 OAK ST SE, SALEM, OR 97301-3905
(503) 814-2154
Mailing address
890 OAK ST SE, SALEM, OR 97301-3905
(503) 814-2154
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200842785RN
OR
363LF0000X
Family Nurse Practitioner
Primary
201408272NP-PP
OR
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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