Individual
MRS. EDNA RUTH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2395 W GRAND BLVD, DETROIT, MI 48208-1210
(313) 897-2061
Mailing address
18001 SAINT MARYS ST, DETROIT, MI 48235-3176
(313) 272-4034
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
4704118498
MI
Other
Enumeration date
11/09/2006
Last updated
07/08/2007
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