Individual
CAROL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4760 W SUNSET BLVD, LOS ANGELES, CA 90027-6063
(323) 783-4011
Mailing address
393 E WALNUT ST, 3RD FLOOR PHR SYSTEMS, PASADENA, CA 91188-0001
(000) 000-0000
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
NA359
CA
Other
Enumeration date
11/29/2006
Last updated
11/29/2007
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