Individual
MISS JACQUELINE ELIZABETH SHANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1030 JEFFERSON AVE, MEMPHIS, TN 38104-2127
(901) 523-8990
Mailing address
2552 NIBLIK PASS APT 202, CORDOVA, TN 38016-4116
(901) 523-8990
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1701
TN
Other
Enumeration date
08/07/2006
Last updated
07/08/2007
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