Individual
CATHERINE M JACKSON
Active
Individual
CATHERINE M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10003594
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039594
LABOR AND INDUSTRIES #
WA
05
—
8368169
—
WA
01
—
JA6697
BLUE SHIELD #
WA
01
—
US1042860
AETNA SPECIALIST PIN
WA
Enumeration date
02/01/2007
Last updated
04/07/2008
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