Individual
MR. MICHAEL WAYNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 FAIRVIEW DR, SOUTHAMPTON MEMORIAL HOSPITAL, FRANKLIN, VA 23851-1238
(757) 569-6125
Mailing address
321 WESTERN AVE, SUFFOLK, VA 23434-4931
(757) 539-4034
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
24099232
VA
Other
Enumeration date
08/04/2006
Last updated
07/08/2007
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