| NPI | 1366725418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Senior Director Provider Enrollment 877-892-9815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2022-01-26 |