Individual
LAKISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GNA
Contact information
Practice address
2250 HICKORY ROAD, SUITE 240, PLYMOUTH MEETING, PA 19462
(610) 834-1122
Mailing address
5002 LODESTONE WAY, APT. J, BALTIMORE, MD 21206
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
A00012637
MD
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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