Individual
DARNESHIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5220 N 67TH ST, MILWAUKEE, WI 53218-3017
(414) 323-3792
Mailing address
5220 N 67TH ST, MILWAUKEE, WI 53218-3017
(414) 323-3792
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
854230292
—
WI
Enumeration date
12/25/2020
Last updated
08/20/2021
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