Individual
MEGAN EZELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Mailing address
155 CROWNE CHASE DR APT 11, WINSTON SALEM, NC 27104-3584
(276) 732-3048
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
225094
NC
Other
Enumeration date
09/23/2013
Last updated
05/04/2022
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