Individual
JACEY LYNN TEETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
1305 N WILLOW ST, LA GRANDE, OR 97850-3822
(541) 663-3200
Mailing address
PO BOX 165, IMBLER, OR 97841-0165
(541) 910-6517
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
202007340RN
OR
Other
Enumeration date
03/07/2024
Last updated
03/07/2024
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