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Individual
ALTRECIA L JACKSON
Active
Individual
ALTRECIA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
880566
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
880566
LPN
LA
Enumeration date
04/03/2017
Last updated
01/03/2019
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