| NPI | 1730121344 |
|---|---|
| Former Name | COURTNEY ANN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: VA 0101243347) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36113297) |
| 208000000X Pediatrics (Licence: IL 36113297) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2016-02-29 |