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Individual

MS. NATHALIE J. JACQMOTTE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6327 SE MILWAUKIE AVE, PORTLAND, OR 97202-5418
(503) 659-4988
(503) 353-1297
Mailing address
PO BOX 22075, MILWAUKIE, OR 97269-2075
(503) 659-4777
(503) 652-5223

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD24071
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080189564
RR MEDICARE
OR
05
286689
OR
Enumeration date
11/29/2005
Last updated
10/31/2008
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