| Doctor Name: | MARVINA JACKSON |
| NPI Number: | 1356584528 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | S4356 |
| Business Practice Address: | 218a Sunset Rd Willingboro, NJ - 080461110 |
| Business Phone Number: | 6098356180 |
| Business Fax Number: | 6098357962 |
| Mailing Address: | 1289 Route 38, HAINESPORT |
| State: | NJ |
| Postal Code: | 080362730 |
| Phone Number: | 6092675656 |
| Fax Number: | 6092678892 |
| NPI Enumeration Date: | 04/17/2009 |
| NPI Last Update Date: | 04/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | S4356 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |