Individual
NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6601 NE 78TH CT STE A3, PORTLAND, OR 97218-2823
(503) 252-3949
(503) 252-4027
Mailing address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
(360) 425-5378
(360) 425-5990
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201130652LPN
OR
Other
Enumeration date
06/03/2016
Last updated
01/29/2019
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