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Individual

KATRINA MARGARET JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
1580 BEAM AVE, MAPLEWOOD, MN 55109-1127
(651) 779-7978
(651) 779-7656
Mailing address
2550 UNIVERSITY AVE W STE 110N, SAINT PAUL, MN 55114-2001
(651) 602-5309
(651) 222-6786

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11676
OH
363L00000X
Nurse Practitioner
Primary
2397795
MN
363L00000X
Nurse Practitioner
4704285871
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201010130
IN
05
3080713
OH
05
7100132960
KY
Enumeration date
08/17/2010
Last updated
11/21/2017
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