| NPI | 1124499124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NISHA MARIE JACKSON Owner/President 541-494-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 086006299N7) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2025-09-15 |