| NPI | 1821363060 |
|---|---|
| Former Name | JULIE LATRACE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN176488) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP128105) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2022-10-28 |