Stephanie Jane Jackson PA

NPI 1457558371 - Physician Assistant - 363AS0400X

NPI Details
NPI 1457558371
Gender Female
Enumeration Date 07/03/2007
Last Updated 04/11/2016
Entity Type Individual
Active Over 9 years ago
Practice Location
2650 RIDGE AVE
WALGREEN BUILDING SUITE 3507
EVANSTON IL, 60201-1718, US
Phone (847) 570-2868
Fax
Business Location
2650 RIDGE AVE
WALGREEN BUILDING SUITE 3507
EVANSTON IL, 60201-1718, US
Phone (847) 570-2868
Fax (813) 254-4517
Toxanomy
Taxonomy Code 363AS0400X
License State Florida
License Number PA9103769
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According to our database, Stephanie Jane Jackson PA NPI is 1457558371, taxonomy code is 363AS0400X and license number is PA9103769, license state is located at Florida. Stephanie Jane Jackson PA physically located at 2650 Ridge Ave, Evanston IL, 60201-1718. NPI Number Stephanie Jane Jackson PA has the Individual type.

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1457558371 NPI number is provided on an as is basis without warranty of any kind. 1457558371 is maintained by the National Plan & Provider Enumeration System. The contents of Stephanie Jane Jackson PA are for informational purposes only.