Individual
MS. PAULETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPED RESP THERAPIST
Contact information
Practice address
108 MAIN STREET, LEWISTON, NC 27849
(252) 826-4040
Mailing address
PO BOX 98, LEWISTON, NC 27849
(252) 348-4000
(252) 348-4001
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
9579
NC
227800000X
Certified Respiratory Therapist
Primary
A1145
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7490010
—
NC
05
—
7795134
—
NC
Enumeration date
05/30/2007
Last updated
05/20/2008
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