Individual
RAVANNA JACKMAN-EL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(667) 234-0430
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(667) 234-0430
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
PR0584
MD
Other
Enumeration date
12/06/2022
Last updated
12/06/2022
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