Nicholas Jackson
Specialist in Moorhead, MN. Individual provider (NPI-1).
NPI number1023720802
StatusActive
Last updated in NPPESDec 23, 2022
Details
- NPI
- 1023720802
- Entity type
- Individual (NPI-1)
- Name
- Nicholas Jackson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 23, 2022
- Certification date
- Dec 23, 2022
- Last updated
- Dec 23, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
Practice location
1505 30th Ave SMoorhead, MN 56560-5149
Phone 218-287-4338
Mailing address
1547 30th Ave SMoorhead, MN 56560-5149
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All 207 Specialist providers in Moorhead · All 1,308 providers in Moorhead
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