Individual
AMY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1420 PLAZA DR, PETOSKEY, MI 49770-9420
(231) 347-7890
Mailing address
1420 PLAZA DR, PETOSKEY, MI 49770-9420
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704312816
MI
Other
Enumeration date
09/04/2015
Last updated
09/04/2015
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