Individual
MRS. KIMIKO RENA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3629 S D ST, TACOMA, WA 98418-6813
(253) 798-4612
Mailing address
3629 S D ST, TACOMA, WA 98418-6813
(253) 798-4612
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60276858
WA
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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