Individual
DIANE L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3901 HOYT AVE, EVERETT, WA 98201-4918
(425) 259-0966
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00001044
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DI00001044
LICENSE
WA
Enumeration date
11/10/2006
Last updated
07/16/2014
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