Individual
LAQUANTA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2430 ATHENS RD, OLYMPIA FIELDS, IL 60461-1954
(708) 790-0366
(708) 844-0264
Mailing address
2430 ATHENS RD, OLYMPIA FIELDS, IL 60461-1954
(708) 790-0366
(708) 844-0264
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041317085
IL
Other
Enumeration date
08/26/2019
Last updated
08/26/2019
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