Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 16-1551 | AZ |
NPI | 1104354901 |
---|---|
Provider Name | Dr. Janice Sue Jackson |
First Address | Fountain Hills, AZ 85269-7844 |
Second Address | Fountain Hills, AZ 85268-4673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |