Individual
LILLIAN RUTH NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
832 NE 162ND AVE, PORTLAND, OR 97230-5765
(503) 262-0145
Mailing address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201607315RN
OR
Other
Enumeration date
02/08/2017
Last updated
02/08/2017
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