Individual
LATICIA S JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4118 ANNAPOLIS AVE, DAYTON, OH 45416-1505
(937) 248-9741
Mailing address
4118 ANNAPOLIS AVE, DAYTON, OH 45416-1505
(937) 248-9741
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
RR641726
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0498434
—
OH
Enumeration date
09/20/2022
Last updated
09/20/2022
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