Individual
DEBORAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
8875 CENTRE PARK DR, SUITE D, COLUMBIA, MD 21045-2114
(410) 730-1000
(410) 730-8615
Mailing address
8875 CENTRE PARK DR, SUITE D, COLUMBIA, MD 21045-2114
(410) 730-1000
(410) 730-8615
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R048240
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
63697401
BLUE SHIELD
MD
01
—
C4280003
BLUE SHIELD
DC
Enumeration date
10/04/2006
Last updated
12/01/2008
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