Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD025329E | PA |
N | 207V00000X | Obstetrician & Gynecologist | MD025329E | PA |
NPI | 1154339810 |
---|---|
Provider Name | Christann L Jackson |
First Address | Pittsburgh, PA 15224-2156 |
Second Address | Pittsburgh, PA 15224-2156 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 02/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001159026 | (05) | PA |
C30206 | (02) | PA |