Individual
JEANNA NICOSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
24934 FIR GROVE LN, ELMIRA, OR 97437-9751
(541) 234-3255
Mailing address
24934 FIR GROVE LN, ELMIRA, OR 97437-9751
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201242522RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201242522RN
OSBN
OR
Enumeration date
05/13/2015
Last updated
09/26/2024
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