| NPI | 1598903270 |
|---|---|
| Former Name | MARANDA C JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R168458) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: MD R168458) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2022-07-13 |