Individual
NICOLE GRACE WHISKEYJACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
46314 TIMINE WAY, PENDLETON, OR 97801-9417
(541) 240-8740
(541) 240-8754
Mailing address
PO BOX 160, PENDLETON, OR 97801-0160
(541) 966-9830
(541) 240-8754
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
20-CRM-173
OR
Other
Enumeration date
07/23/2020
Last updated
01/20/2023
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