Individual
NICOLE DANIELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, CSCS
Contact information
Practice address
5300 PACIFIC AVE SE, LACEY, WA 98503-7500
(360) 438-4536
(360) 438-4568
Mailing address
2213 SW SISKIN CIR, PORT ORCHARD, WA 98367-6200
(360) 438-4536
(360) 438-4568
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/18/2008
Last updated
06/18/2008
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