Individual
JADE NICHOLE BOURBONNAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18980 LELAND RD, OREGON CITY, OR 97045-8511
(503) 238-0769
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
05/22/2012
Last updated
05/22/2012
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