| NPI | 1497164446 |
|---|---|
| Former Name | MARY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO APN.0996054-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS f0614908) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2022-03-09 |