| NPI | 1427623750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA YVETTE JACKSON Nurse Practitioner 443-418-4254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2021-10-02 |