Individual
MRS. ALEXANDRA M JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
8716 E MILL PLAIN BLVD, SPECIALTY CLINICS BUILDING, VANCOUVER, WA 98664-2531
(360) 514-7932
Mailing address
8716 E MILL PLAIN BLVD, SPECIALTY CLINICS BUILDING, VANCOUVER, WA 98664-2531
(360) 514-7932
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
560
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8404915
—
OR
Enumeration date
11/11/2006
Last updated
10/10/2013
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