Individual
RUTH V JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
415 N 9TH ST, 4W16, SPRINGFIELD, IL 62702-5303
(800) 331-2229
(217) 757-6844
Mailing address
PO BOX 19676, SPRINGFIELD, IL 62794-9676
(800) 331-2229
(217) 757-6844
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-003223
IL
Other
Enumeration date
05/16/2007
Last updated
02/15/2011
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