| NPI | 1619370160 |
|---|---|
| Former Name | JORDAN L JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601007728) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085005249) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2018-01-19 |