Individual
LATIA SADE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 S HEWITT RD, APT 204, YPSILANTI, MI 48197-4487
(989) 746-4360
Mailing address
230 S HEWITT RD, APT 204, YPSILANTI, MI 48197-4487
(989) 746-4360
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247200000
TECHNICIAN
MI
Enumeration date
11/22/2015
Last updated
11/22/2015
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