Individual
MISS LATRICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2010 216TH ST, SAUK VILLAGE, IL 60411-4506
(708) 668-5449
Mailing address
14200 S PARNELL AVE, RIVERDALE, IL 60827-2313
(708) 668-5449
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041398810
IL
Other
Enumeration date
07/29/2024
Last updated
07/29/2024
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