Individual
MS. COLLEEN DELORES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
8700 BEVERLY BLVD, THALIANS 2W, RM 218, WEST HOLLYWOOD, CA 90048-1804
(310) 423-8572
(310) 423-8550
Mailing address
849 MANZANITA AVE, PASADENA, CA 91103-2961
(310) 423-8572
(310) 423-8550
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12835
CA
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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