Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2403 | SC |
NPI | 1013010941 |
---|---|
Provider Name | Ms. Linda Olin Jackson |
First Address | Charleston, SC 29401-5789 |
Second Address | Charleston, SC 29401-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |