| NPI | 1194768721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Sr. Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics |
| Additional Taxonomies | 208D00000X General Practice |
| 367A00000X Advanced Practice Midwife | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2022-11-03 |