Individual
TIFFANY NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
589 NW 11TH ST, HERMISTON, OR 97838-6600
(541) 567-1717
(541) 564-5994
Mailing address
589 NW 11TH ST, HERMISTON, OR 97838-6600
(541) 567-1717
(541) 564-5994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA179818
OR
Other
Enumeration date
08/04/2016
Last updated
03/22/2021
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