Individual
MRS. DIANNE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5250 NEW JERSEY AVE, FORT DIX, NJ 08640-5017
(609) 562-6965
Mailing address
507 JOHN R BLVD, SIKESTON, MO 63801-2443
(573) 471-7113
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
098462
MO
Other
Enumeration date
02/06/2006
Last updated
07/08/2007
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