Individual
MARISSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 N CORONADO DR, SUITE A, SIERRA VISTA, AZ 85635-6358
(520) 792-1450
Mailing address
2883 MOUNTAIN RIDGE DR, SIERRA VISTA, AZ 85650-7517
(520) 803-9926
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN100325
AZ
Other
Enumeration date
03/27/2009
Last updated
03/27/2009
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