Individual
JESSICA LYNN LUCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
940 ROYAL AVE, STE 350, MEDFORD, OR 97504-6193
(541) 732-7460
(541) 732-7461
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-7460
(541) 732-7461
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
201400211NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500667248
—
OR
Enumeration date
01/13/2014
Last updated
03/19/2021
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