Individual
MS. BERTHA ADELE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
5501 OLD YORK RD, PALEY FIRST FLOOR, PHILADELPHIA, PA 19141-3018
(215) 456-6532
(215) 456-7375
Mailing address
5501 OLD YORK RD, PALEY FIRST FLOOR, PHILADELPHIA, PA 19141-3018
(215) 456-6532
(215) 456-7375
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP010712
PA
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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