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General NPI Number Information
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NPI Number | 1902622178
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Entity Type | Individual
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Provider Name | MACHERI JACKSON
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 161 E RIVULON BLVD STE 210
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City | GILBERT
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State | AZ
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Zip | 85297-0087
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Country | US
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Telephone | 480-494-2465
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Fax |
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Provider Business Mailing Address
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Address Line | 380 LAVA LN
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City | UNION CITY
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State | GA
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Zip | 30291-5187
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Country | US
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Telephone | 229-256-9353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN-244704
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License Number State | GA
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