Individual
NURISHA SHAVON JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-3442
Mailing address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-3442
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
R191018
MD
367A00000X
Advanced Practice Midwife
Primary
0024177805
VA
Other
Enumeration date
06/05/2018
Last updated
11/21/2023
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