Individual
JINGLE DIAZ SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3180 CENTER ST NE, SALEM, OR 97301-4532
(503) 588-5613
Mailing address
4498 COUNTRYSIDE CT NE, SALEM, OR 97305-3196
(503) 983-3400
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201130650LPN
OR
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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