Individual
EMMA J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
33048 CANOPY LN, LAKE ELSINORE, CA 92532-2535
(909) 614-3039
Mailing address
33048 CANOPY LN, LAKE ELSINORE, CA 92532-2535
(909) 614-3039
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN95042368
CA
163WP0200X
Pediatric Registered Nurse
Primary
95042368
CA
363LF0000X
Family Nurse Practitioner
NP950147
CA
Other
Enumeration date
11/06/2018
Last updated
08/07/2020
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