Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD61016066 | WA |
NPI | 1003347550 |
---|---|
Provider Name | Dr. Alana Jean Jackson |
First Address | Wenatchee, WA 98801-2028 |
Second Address | Omak, WA 98841-9759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2017 |
Last Update Date | 23/07/2020 |