Individual
BREONKA MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
615 BARONNE ST STE 304, NEW ORLEANS, LA 70113
(504) 814-8001
Mailing address
5220 FOREST PARK LN, NEW ORLEANS, LA 70131-8583
(504) 215-9094
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/05/2016
Last updated
07/02/2019
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