Individual
MICHAELA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 WASHINGTON ST, BOSTON, MA 02111-1552
(617) 636-6317
Mailing address
3 E SHORE, LAGUNA NIGUEL, CA 92677-4241
(949) 275-7909
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/06/2023
Last updated
07/24/2023
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