Individual
MS. SAMALA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1055 WESTLAKES DR STE 3152, BERWYN, PA 19312-2410
(215) 346-6050
(215) 220-3562
Mailing address
PO BOX 40412, BELFAST, ME 04915-1255
(248) 824-6500
(855) 618-6655
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
SP018935
PA
Other
Enumeration date
05/24/2022
Last updated
10/24/2025
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