| NPI | 1497164446 |
|---|---|
| Former Name | MARY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 2024043303) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0996054-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS F0614908) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2025-08-28 |