Individual
DIANE MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
12517 ERWIN AVE, CLEVELAND, OH 44135-3554
(216) 507-1400
Mailing address
12517 ERWIN AVE, CLEVELAND, OH 44135-3554
(216) 507-1400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.370239
OH
Other
Enumeration date
08/01/2012
Last updated
10/08/2015
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