Individual
REGULA R. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, OB-GYN NP
Contact information
Practice address
4212 NORTH 16TH STREET, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1637
Mailing address
P.O.BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1637
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
RN057918
AZ
367A00000X
Advanced Practice Midwife
Primary
RN057918
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
451667
—
AZ
01
—
AZ0145750
BCBS
AZ
Enumeration date
10/03/2006
Last updated
08/23/2011
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