| NPI | 1538505318 |
|---|---|
| Former Name | AMY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MI 4704191045) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704191045) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2024-11-04 |