NPI | 1063669893 |
---|---|
Former Name | MAHALIA L JACKSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP117597) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 715590) |
363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP117597) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP117597) | |
Enumeration Date | 2008-08-22 |
Last Update Date | 2024-08-27 |