Individual
BROOKE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1157 S ADAMS RD, BIRMINGHAM, MI 48009-7101
(248) 594-4006
Mailing address
1157 S ADAMS RD, BIRMINGHAM, MI 48009-7101
(248) 594-4006
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1184942
MI
Other
Enumeration date
01/02/2021
Last updated
12/08/2022
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