Individual
ALI NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 WEMBLEY PARK RD, LAKE OSWEGO, OR 97034-2632
(503) 745-6568
(503) 734-6568
Mailing address
2800 WEMBLEY PARK RD, LAKE OSWEGO, OR 97034-2632
(503) 745-6568
(503) 734-6568
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
200340761RN
OR
Other
Enumeration date
12/16/2025
Last updated
12/16/2025
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