Individual
NANCY ANN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1010 DANCONIA DR, TRAIL, OR 97541-9702
(541) 878-2869
Mailing address
150 SCHOOLHOUSE LN, SHADY COVE, OR 97539-9401
(541) 951-0561
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18436
OR
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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