| NPI | 1982150892 |
|---|---|
| Former Name | SHAUNA-DEAN ANTOINETTE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 818032) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9311091) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2024-09-30 |