Individual
NICHOLE ROSE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3175 SIENNA DR S, FARGO, ND 58104-8910
(701) 205-3088
(701) 335-7808
Mailing address
530 3RD ST E, WEST FARGO, ND 58078-2711
(701) 205-3088
(701) 335-7808
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R31008
ND
Other
Enumeration date
07/02/2012
Last updated
09/23/2016
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