Individual
MRS. ELIZABETH ANNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704280272
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704280272
MI
Other
Enumeration date
06/04/2021
Last updated
01/02/2024
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