Individual
OSTASSIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11431 N PORT WASHINGTON RD STE 206, MEQUON, WI 53092-3462
(414) 319-9195
Mailing address
11431 N PORT WASHINGTON RD STE 206, MEQUON, WI 53092-3462
(414) 319-9195
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
177F00000X
Lodging Provider
—
—
251E00000X
Home Health Agency
Primary
—
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
08/14/2022
Last updated
08/14/2022
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