| NPI | 1639353485 |
|---|---|
| Former Name | BRIDGET MARIE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 47521) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 6805153) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2020-05-05 |