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Individual

LATESHIA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8737 BROOKS DR STE 108, EASTON, MD 21601-7474
(800) 867-2395
(410) 443-4960
Mailing address
8142 HAROLD CT, GLEN BURNIE, MD 21061-4960
(202) 253-3588

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R193593
MD

Other

Enumeration date
10/24/2013
Last updated
09/18/2019
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