| NPI | 1972020865 |
|---|---|
| Former Name | BRENDA LEE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024174172) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0024174172) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: VA 0024174172) | |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2023-11-16 |