Individual
MR. JACK ALLAN SOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
MEDICAL CENTER 400 NE, MOTHER JOSEPH PLACE, VANCOUVER, WA 98668-9989
(360) 514-2000
Mailing address
16506 NE 28TH AVE, RIDGEFIELD, WA 98642-8958
(360) 609-2898
Taxonomy
Speciality
Code
Description
License number
State
364SP2800X
Perioperative Clinical Nurse Specialist
Primary
RN00061877
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN00061877
REGISTERED NURSE
WA
Enumeration date
04/24/2007
Last updated
07/08/2007
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