Individual
AMBER NICOLE JAMEKA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
495 E MAIN ST STE A, COLUMBUS, OH 43215-5349
(614) 355-8055
(614) 355-8056
Mailing address
DEPT. 781625, PO BOX 78000, DETROI, MI 48278-1625
(614) 355-8004
(614) 355-2220
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
05/01/2018
Last updated
05/01/2018
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