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1174961551
ERIN MIRANDA JACKSON
COLUMBIA, SC
NPI
1174961551
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IL 041347034)
Enumeration Date
2013-06-07
Last Update Date
2013-06-07
Business Address
-- ERIN MIRANDA JACKSON FNP
4500 STUART ST
COLUMBIA, SC 29207-5700
Phone number: 309-360-5141
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Mailing Address
-- ERIN MIRANDA JACKSON FNP
14908 MCKNEW RD
BURTONSVILLE, MD 20866-1339
Phone number: 309-360-5141
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