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Individual

LASHAWNNA CHANEL JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
6307 S STEWART AVE STE 205, CHICAGO, IL 60621-3116
(773) 868-6824
Mailing address
1044 N FRANCISCO AVE STE 404, CHICAGO, IL 60622-2743
(773) 868-6824

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
363LF0000X
Family Nurse Practitioner
Primary
277003168
IL

Other

Enumeration date
10/06/2021
Last updated
06/08/2025
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