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Individual

SEOLAR L JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMNP-BC

Contact information

Practice address
768 DELAWARE AVE, BUFFALO, NY 14209-2006
(716) 882-3151
(716) 886-4002
Mailing address
2605 SWEET HOME RD, AMHERST, NY 14228-2129
(716) 444-8635

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
621214
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403929
NY

Other

Enumeration date
05/07/2015
Last updated
11/09/2022
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