Individual
MRS. JENNIFER NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
4948 SW MEADOW AVE, LAKE OSWEGO, OR 97035-2216
(503) 744-2061
Mailing address
4948 SW MEADOW AVE, LAKE OSWEGO, OR 97035-2216
(503) 744-2061
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
LD-D-10159758
OR
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
966403
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
966403
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
05/05/2014
Last updated
01/18/2024
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