Individual
TRACEY FRANCINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22764 NORMANDY AVE, EASTPOINTE, MI 48021-1854
(313) 782-6777
Mailing address
22764 NORMANDY AVE, EASTPOINTE, MI 48021-1854
(313) 782-6777
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
07/07/2016
Last updated
07/07/2016
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