Individual
ANGELA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 E ST, PITTSFIELD, ME 04967-5106
(207) 355-4026
Mailing address
110 E ST, PITTSFIELD, ME 04967
(207) 355-4026
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1666300
ME
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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