Individual
ANITA MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3200 KILBURN RD, PHILADELPHIA, PA 19114-1107
(215) 964-4492
Mailing address
3200 KILBURN RD, PHILADELPHIA, PA 19114-1107
(215) 964-4492
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN318856
PA
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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