| NPI | 1447319330 |
|---|---|
| Former Name | MARY LOUISE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30004306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00037524) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-11-10 |