Individual
MS. PAMELA KENNA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1496 VILLAGE RD APT A, UNION, NJ 07083-4461
(201) 284-2307
Mailing address
1496 VILLAGE RD APT A, UNION, NJ 07083-4461
(201) 284-2307
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
J00626147258862
NJ
Other
Enumeration date
10/12/2018
Last updated
01/09/2024
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