Individual
SHANNON LAURA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2301 ERWIN RD, DURHAM, NC 27705-4699
(530) 220-4806
Mailing address
2301 ERWIN RD, DURHAM, NC 27705-4699
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
294964
NC
Other
Enumeration date
03/25/2020
Last updated
03/25/2020
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