Individual
MRS. TYSHALL SHAMICK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
900 DUDLEY AVE, CHERRY HILL, NJ 08002-4426
(856) 541-1700
Mailing address
5308 HALPIN AVE, PENNSAUKEN, NJ 08109-1132
(856) 397-7626
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR10973200
NJ
Other
Enumeration date
04/22/2009
Last updated
04/22/2009
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