| NPI | 1063669893 |
|---|---|
| Former Name | MAHALIA L JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP117597) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 715590) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2024-06-05 |