Individual
PAMELA LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
353 BLAIR PARK RD, WILLISTON, VT 05495-7530
(802) 847-1440
(802) 847-3014
Mailing address
4 HARBOR RIDGE RD, SOUTH BURLINGTON, VT 05403-7849
(802) 863-8962
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
42-0008559
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E01148865
—
NY
05
—
OVN0393
—
VT
Enumeration date
06/28/2006
Last updated
01/08/2015
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