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Individual

JAKSON NICHOLAS EDWARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
4585 SW 185TH AVE, ALOHA, OR 97078-1557
(503) 591-9280
Mailing address
1865 RAINBOW RD APT 106, CHEYENNE, WY 82001-6583
(307) 275-2640

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
202106698RN
OR
251B00000X
Case Management Agency
132080700
WY

Other

Enumeration date
12/31/2012
Last updated
07/12/2021
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