Individual
ERIN MIRANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4500 STUART ST, COLUMBIA, SC 29207-5700
(309) 360-5141
Mailing address
14908 MCKNEW RD, BURTONSVILLE, MD 20866-1339
(309) 360-5141
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
041347034
IL
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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