Individual
MS. ANITRA L JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
310 SMITH AVE N, SAINT PAUL, MN 55102-2393
(952) 843-4333
(952) 843-4301
Mailing address
310 SMITH AVE N, SAINT PAUL, MN 55102-2383
(952) 843-4333
(952) 843-4301
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
R1308387
MN
Other
Enumeration date
04/07/2006
Last updated
07/08/2007
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