Individual
JESSICA ANTOINETTE NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5725 NE PRESCOTT ST, PORTLAND, OR 97218-2275
(503) 548-8085
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
11/27/2020
Last updated
11/27/2020
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