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NPI Profile for EDNA R JACKSON in DETROIT, MI.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Administrator |
163WA2000X |
| NPI Number | 1114097870 |
|
| Status | Active | |
| Credentials | RN (Registered Nurse) | |
| Entity | Individual | |
| Enumeration date | 11/09/2006 | |
| Last updated | 07/08/2007 - About 19 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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EDNA R JACKSON
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EDNA R JACKSON, RN