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NPI Profile for ALYSSA J JACKSON in SEBEKA, MN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI # | 1487266078 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 08/17/2020 | |
| Last updated | 02/05/2024 - About 2 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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ALYSSA J JACKSON
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ALYSSA J JACKSON