Individual provider · Type 1 NPI
Bertha Adele Jackson, CRNP
Family Nurse Practitioner · Philadelphia, PA
NPI number
1598078404
Active
Practice location
5501 Old York Rd, Paley First Floor
Philadelphia, PA 19141-3018
Fax (215) 456-7375
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | SP010712 (PA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1598078404
Bertha Adele Jackson, CRNP's National Provider Identifier is 1598078404, issued on Jul 20, 2010. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Philadelphia, PA. The record was last updated on Jul 20, 2010.