Individual
MR. MICHAEL BEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 ADELE AVE, BREMERTON, WA 98312-3521
(360) 782-0129
(360) 377-8029
Mailing address
220 NE LARSON LAKE RD, BELFAIR, WA 98528-9404
(360) 782-0129
(360) 377-8029
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP30003880
WA
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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