Individual
MRS. LAURA MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, CWCN
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
PO BOX 2276, LONGVIEW, WA 98632-8347
(360) 430-7448
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201250183NP
OR
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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