Individual
MRS. ANGELA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13 SLATE CREEK DR APT 5, CHEEKTOWAGA, NY 14227-2947
(716) 536-6757
Mailing address
13 SLATE CREEK DR APT 5, CHEEKTOWAGA, NY 14227-2947
(716) 536-6757
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
254006
NY
Other
Enumeration date
03/11/2014
Last updated
10/19/2016
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