Individual
MS. JUDITH JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1395
(612) 672-2288
Mailing address
6341 26TH ST N, OAKDALE, MN 55128-3505
(651) 779-0954
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R1144729
MN
Other
Enumeration date
04/26/2006
Last updated
07/08/2007
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