Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MRS. JENNIFER NICKELL, MS, RD, LD
ActivePediatric Nutrition · LAKE OSWEGO, OR
Registration Details
- NPI Number
- 1164832713
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- May 5, 2014 (11.964300626749 yrs)
- Last Updated
- Jan 18, 2024
- Licenses
-
LD-D-10159758 (OR)966403
Practice Information
- Address
-
4948 SW MEADOW AVELAKE OSWEGO, OR, 970352216Browse OR providers · Browse ZIP 97035
- Phone
- 5037442061
- Primary Specialty
-
Pediatric Nutrition
133VN1004X
- Additional Specialty
- Pediatric Nutrition
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.