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Contact Information

NICOLE K JACKSON, DO
525 LILLY RD NE STE 200
OLYMPIA, WA98506
 Phone: 360-493-4510
 Fax: 360-493-7759
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Thoracic Surgery (Cardiothoracic Vascular Surgery)

208G00000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for NICOLE K JACKSON · (Female)

NPI # 1508188343
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 02/21/2010
Last updated 06/12/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • WA License # OP60418108
  • WA Medicaid OL60099734
Hospital affiliation(s)
  • PEACEHEALTH ST JOSEPH MEDICAL CENTER - (Acute Care)
    2901 SQUALICUM PARKWAY
    BELLINGHAM, WA 98225
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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