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NICOLE KIMBERLY JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
525 LILLY RD NE STE 200, OLYMPIA, WA 98506
(360) 493-4510
(360) 493-7759
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
OP60418108
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
OL60099734
WA
Enumeration date
02/21/2010
Last updated
06/12/2018
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