Individual
CORNETTA KAY ORTONJACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4516 HUNTERS POINT DR, PORTSMOUTH, VA 23703-2220
(757) 724-2122
Mailing address
4516 HUNTERS POINT DR, PORTSMOUTH, VA 23703-2220
(757) 724-2122
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001120432
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08111966
—
VA
Enumeration date
10/30/2021
Last updated
10/30/2021
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