| NPI | 1902445281 |
|---|---|
| Former Name | JULIANNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA13765) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2021-08-05 |