Individual
MICHELLE MARIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
220 E 89TH ST, BROOKLYN, NY 11236-1418
(718) 690-5751
Mailing address
220 E 89TH ST, BROOKLYN, NY 11236-1418
(718) 690-5751
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
397531715
—
NY
Enumeration date
12/20/2018
Last updated
12/20/2018
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