Individual
LASHANDA JANICE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8033 E 10 MILE RD STE 114, CENTER LINE, MI 48015-1454
(586) 756-6661
(586) 756-6933
Mailing address
8033 E 10 MILE RD STE 114, CENTER LINE, MI 48015-1454
(586) 756-6661
(586) 756-6933
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703101476
MI
Other
Enumeration date
04/20/2018
Last updated
04/20/2018
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