Individual
DANIELLE MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4 HAWK NEST LN APT 2, WALLKILL, NY 12589-2630
(845) 514-5844
Mailing address
4 HAWK NEST LN APT 2, WALLKILL, NY 12589-2630
(845) 514-5844
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
294175-1
NY
Other
Enumeration date
01/24/2016
Last updated
01/24/2016
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