Individual
JENNIFER M NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2485 12TH ST SE, SALEM, OR 97302-2151
(503) 363-8047
(503) 363-6571
Mailing address
30494 SW RUTH ST, WILSONVILLE, OR 97070-8692
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200040937RN
OR
363LF0000X
Family Nurse Practitioner
Primary
202010122NP-PP
OR
Other
Enumeration date
10/02/2020
Last updated
12/09/2025
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