| NPI | 1740578103 |
|---|---|
| Former Name | DIANNE GENENE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OK 1148) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: OK R0083080) |
| 163WX0800X Registered Nurse, Orthopedic (Licence: OK 83080) | |
| 363AS0400X Physician Assistant, Surgical (Licence: OK 1148) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-06-08 |