Individual
MRS. JACQUELINE MARIE PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1255 LAUREL STREET, FLORENCE, OR 97439-0119
(541) 997-4015
Mailing address
PO BOX 1839, FLORENCE, OR 97439-0119
(541) 997-4015
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
200630279LPN
OR
Other
Enumeration date
06/02/2010
Last updated
12/27/2010
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