| NPI | 1689329435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EDWARD JACKSON Owner/Family Nurse Practitioner 202-568-6579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |