Individual
KATRINA MARCIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3 SHAWS CV STE 206, NEW LONDON, CT 06320-4968
(860) 443-4148
Mailing address
402 CENTER ST, WEST HAVEN, CT 06516-4204
(405) 464-8126
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
576
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
576
CONNECTICUT STATE NURSE MIDWIFE LICENSE
CT
Enumeration date
07/29/2024
Last updated
07/29/2024
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