Individual
MRS. POLLY REBECCA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
901 E 5TH ST, WASHINGTON, MO 63090-3127
(636) 239-8231
Mailing address
901 E 5TH ST, WASHINGTON, MO 63090-3127
(636) 239-8231
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2015041436
MO
Other
Enumeration date
12/03/2015
Last updated
10/25/2022
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