Individual
ANDRIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9560 MARLBORO PIKE STE 105, UPPER MARLBORO, MD 20772-3770
(301) 535-7542
Mailing address
9560 MARLBORO PIKE STE 105, UPPER MARLBORO, MD 20772-3770
(301) 535-7542
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
407120
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
407120
COSMETOLOGY LICENCE
MD
Enumeration date
06/12/2020
Last updated
06/12/2020
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