| NPI | 1972030252 |
|---|---|
| Former Name | ETHETA MARIA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557533) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 103631) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2026-01-09 |