Individual
MARIALIZA GODOY PADILLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, MSN,PMHNP-BC
Contact information
Practice address
51999 COPPER CREEK CT, CHESTERFIELD, MI 48047-5968
(586) 275-9658
Mailing address
51999 COPPER CREEK CT, CHESTERFIELD, MI 48047-5968
(586) 275-9658
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704188063
MI
Other
Enumeration date
05/10/2023
Last updated
06/03/2024
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