Provider Demographics
NPI:1255958146
Name:JACKSON, BRITTANY L (MIDWIFE)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:L
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1619 DAYTON AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6276
Mailing Address - Country:US
Mailing Address - Phone:612-275-8438
Mailing Address - Fax:612-446-5776
Practice Address - Street 1:1619 DAYTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6276
Practice Address - Country:US
Practice Address - Phone:612-275-8438
Practice Address - Fax:612-446-5776
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife