Individual
TENITA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 JERALD DR, MONROE, LA 71203-6708
(318) 737-7079
Mailing address
100 JERALD DR, MONROE, LA 71203-6708
(318) 737-7079
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Enumeration date
12/07/2011
Last updated
10/17/2012
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