Individual
MRS. GLENDA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
117 W LIBERTY STREET, ROME, NY 13440
(315) 339-0401
(315) 339-2957
Mailing address
117 W LIBERTY STREET, ROME, NY 13440
(315) 339-0401
(315) 339-2957
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
F3340511
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03353028
—
NY
Enumeration date
11/02/2006
Last updated
03/19/2013
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