Individual
LECHEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35040 RENFREW ST, HARRISON TOWNSHIP, MI 48045-3605
(313) 737-9195
Mailing address
35040 RENFREW ST, HARRISON TOWNSHIP, MI 48045-3605
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704296540
MI
Other
Enumeration date
01/25/2018
Last updated
01/25/2018
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