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Individual

MICHELLE LYNN JACKSON

Active
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Individual

MICHELLE LYNN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
209.019281
IL
363LF0000X
Family Nurse Practitioner
Primary
209019281
IL

Other

Enumeration date
06/29/2019
Last updated
12/14/2024
About Stedi
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