Individual
PATRICIA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
230 W CATALPA DR, SUITE D, MISHAWAKA, IN 46545-8321
(574) 257-7551
(574) 257-7535
Mailing address
230 CATALPA, SUITE D, MISHAWAKA, IN 46545
(574) 257-7551
(574) 257-7535
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001911A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200519100
—
IN
Enumeration date
07/28/2006
Last updated
07/05/2019
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