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Individual
DIANE L JACKSON
Active
Individual
DIANE L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00001044
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DI00001044
LICENSE
WA
Enumeration date
11/10/2006
Last updated
07/16/2014
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