Basic Information
Provider Information
NPI: 1962594655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JACKMAN
FirstName: MARGARET
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 839 W CONGRESS ST
Address2:  
City: TUCSON
State: AZ
PostalCode: 857452819
CountryCode: US
TelephoneNumber: 5207929890
FaxNumber: 5208849287
Practice Location
Address1: 225 W IRVINGTON RD
Address2:  
City: TUCSON
State: AZ
PostalCode: 857143054
CountryCode: US
TelephoneNumber: 5208847304
FaxNumber: 5206230992
Other Information
ProviderEnumerationDate: 09/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102XRN109074AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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