| NPI | 1952571184 |
|---|---|
| Former Name | REBECCA LYNNE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-832) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10005348) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2024-07-10 |