Individual
MS. TONYA L. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N 67TH AVE, PHOENIX, AZ 85033-4517
(623) 691-4085
Mailing address
561 N. SIRRINE ST., MESA, AZ 85201
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP965595
AZ
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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