Individual
MARIE R. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
310 S LIMESTONE, LEXINGTON, KY 40508-3008
(859) 252-6612
Mailing address
PO BOX 637931, CINCINNATI, OH 45263-7931
(615) 327-4304
(615) 327-7940
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
19290
TN
Other
Enumeration date
01/21/2015
Last updated
04/05/2016
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