| Doctor Name: | MS. CAROL BOWSER JACKSON |
| NPI Number: | 1063582864 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R103314 |
| Business Practice Address: | 9501 Farrell Rd Bldg 815,rm 139 Fort Belvoir, VA - 220605901 |
| Business Phone Number: | 7038050498 |
| Business Fax Number: | |
| Mailing Address: | 5805 Terence Dr, CLINTON |
| State: | MD |
| Postal Code: | 207353742 |
| Phone Number: | 3018565259 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WX0106X |
| License Number: | R103314 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Occupational Health |
| Taxonomy Definition: | |