| NPI | 1083271753 |
|---|---|
| Former Name | LAVERN N JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA 201872) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN201872) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-12-20 |