Doctor Name: | BRENDA ANN JACKSON |
NPI Number: | 1326273707 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 100 Lake Traverse Dr Sisseton, SD - 572627046 |
Business Phone Number: | 6056987606 |
Business Fax Number: | |
Mailing Address: | Po Box 651, AGENCY VILLAGE |
State: | SD |
Postal Code: | 572620651 |
Phone Number: | 6056987606 |
Fax Number: | |
NPI Enumeration Date: | 05/28/2009 |
NPI Last Update Date: | 05/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 247100000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |