| Doctor Name: | DIANE L JACKSON |
| NPI Number: | 1891866034 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | DI00001044 |
| Business Practice Address: | 3901 Hoyt Ave Everett, WA - 982014918 |
| Business Phone Number: | 4252590966 |
| Business Fax Number: | |
| Mailing Address: | Po Box 5127, EVERETT |
| State: | WA |
| Postal Code: | 982065127 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/10/2006 |
| NPI Last Update Date: | 07/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | DI00001044 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |