Gloria L Jackson CRNP

NPI 1013035294 - Nurse Practitioner - 363L00000X

NPI Details
NPI 1013035294
Gender Female
Enumeration Date 03/27/2007
Last Updated 04/13/2012
Entity Type Individual
Active Over 9 years ago
Practice Location
3400 CIVIC CENTER BLVD
PCAM 4 WEST
PHILADELPHIA PA, 19104, US
Phone (215) 615-5858
Fax (215) 349-8144
Business Location
3400 CIVIC CENTER BLVD
PCAM 4 WEST
PHILADELPHIA PA, 19104, US
Phone (215) 615-5858
Fax (215) 349-8144
Toxanomy
Taxonomy Code 363L00000X
License State Pennsylvania
License Number SP007231
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According to our database, Gloria L Jackson CRNP NPI is 1013035294, taxonomy code is 363L00000X and license number is SP007231, license state is located at Pennsylvania. Gloria L Jackson CRNP physically located at 3400 Civic Center Blvd, Philadelphia PA, 19104. NPI Number Gloria L Jackson CRNP has the Individual type.

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1013035294 NPI number is provided on an as is basis without warranty of any kind. 1013035294 is maintained by the National Plan & Provider Enumeration System. The contents of Gloria L Jackson CRNP are for informational purposes only.