Individual
MARY LOUISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1500 PHYSICIANS DR, WILMINGTON, NC 28401-7356
(910) 662-9500
(910) 662-9501
Mailing address
PO BOX 936857, ATLANTA, GA 31193-6857
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
900188
NC
Other
Enumeration date
08/23/2006
Last updated
03/15/2022
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