| NPI | 1992365902 |
|---|---|
| Former Name | ANGELINE KATHLEEN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MD R175676) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R175676) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2020-12-16 |