Individual
HEIDI ERICKA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
15606 NE 12TH WAY, VANCOUVER, WA 98684
(541) 401-3098
Mailing address
15606 NE 12TH WAY, VANCOUVER, WA 98684-4158
(541) 401-3098
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
201801572RN
OR
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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