Individual
MICHELLE CHRISTINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
9550 195TH AVE E, BONNEY LAKE, WA 98391-5969
(253) 447-3400
Mailing address
PO BOX 73939, PUYALLUP, WA 98373-0939
(253) 720-4642
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP61083974
WA
Other
Enumeration date
05/05/2020
Last updated
04/11/2022
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