Individual
MR. JOURDAN CLIVE NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
7103 W GRANDRIDGE BLVD, SUITE F, KENNEWICK, WA 99336-6713
(509) 582-2057
(509) 374-4945
Mailing address
7103 W GRANDRIDGE BLVD, SUITE F, KENNEWICK, WA 99336-6713
(509) 582-2057
(509) 374-4945
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO549
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101377
—
WA
01
—
89978401
LABOR & INDUST
WA
Enumeration date
02/01/2007
Last updated
07/30/2013
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