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Individual

JOHANNA ELLEN FICKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.N.

Contact information

Practice address
1270 KOT-NUM RD, WARM SPRINGS, OR 97761
(541) 553-1196
(541) 553-2457
Mailing address
PO BOX 215, MADRAS, OR 97741-0036
(541) 553-1196
(541) 553-2457

Taxonomy

Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
027695
ME

Other

Enumeration date
10/06/2006
Last updated
07/08/2007
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