Individual
MS. KAREN LYNETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2915 N 44TH ST, MILWAUKEE, WI 53210-1710
(414) 449-5105
Mailing address
2915 N 44TH ST, MILWAUKEE, WI 53210-1710
(414) 449-5105
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
29404-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39877300
EDS
—
Enumeration date
06/12/2007
Last updated
07/08/2007
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