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Individual
LAURA JACKSON
Active
Individual
LAURA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024181249
VA
363L00000X
Nurse Practitioner
Primary
R205686
MD
363LA2200X
Adult Health Nurse Practitioner
0024181249
VA
363LA2200X
Adult Health Nurse Practitioner
R205686
MD
363LG0600X
Gerontology Nurse Practitioner
0024181249
VA
363LG0600X
Gerontology Nurse Practitioner
R205686
MD
Other
Enumeration date
04/13/2021
Last updated
04/13/2021
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