Individual
MS. AMANDA EMILY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P
Contact information
Practice address
925 CHESTNUT ST, SUITE 320A, PHILADELPHIA, PA 19107-4216
(215) 955-8874
Mailing address
925 CHESTNUT ST, SUITE 320A, PHILADELPHIA, PA 19107-4216
(215) 955-8874
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP013151
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102903630
—
PA
Enumeration date
08/30/2013
Last updated
06/10/2014
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