Individual
MICHELLEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
NAVAJO ROUTE 4 TWO MILES EAST OF PINON, PINON, AZ 86510
(928) 725-9500
(928) 725-9654
Mailing address
PO BOX PH, CHINLE, AZ 86503-8000
(928) 674-7001
(928) 674-7705
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN149006
AZ
Other
Enumeration date
12/05/2007
Last updated
12/05/2007
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