Individual
CALLIE RAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10520 S 123RD AVE, PAPILLION, NE 68046-4393
(402) 514-3650
Mailing address
10520 S 123RD AVE, PAPILLION, NE 68046-4393
(402) 514-3650
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3747P1801X
—
NE
Enumeration date
09/07/2022
Last updated
09/07/2022
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