Individual
JENNA NURA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
624 E 9 MILE RD, HAZEL PARK, MI 48030-1842
(248) 629-7497
Mailing address
30575 WOODWARD AVE, ROYAL OAK, MI 48073-0980
(248) 280-8550
(248) 280-8571
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010079
MI
Other
Enumeration date
11/13/2020
Last updated
12/01/2020
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