Individual
MRS. LAURENA S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
300 FOUNTAIN ROAD, ROCKY MOUNT, NC 27802
(252) 442-9712
(252) 442-1413
Mailing address
1713 SAGAMORE CT, RALEIGH, NC 27604-4743
(252) 442-9712
(252) 442-1413
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
101493
NC
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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