Individual
MARY JANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., N.P.
Contact information
Practice address
1204 W MAIN ST, CHARLOTTESVILLE, VA 22903-2824
(434) 924-0123
(434) 924-3300
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024167194
VA
Other
Enumeration date
05/24/2007
Last updated
07/29/2021
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