Individual
DIANNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1035 HUNTERS CREEK DR, DESOTO, TX 75115-4712
(513) 502-8457
Mailing address
1035 HUNTERS CREEK DR, DESOTO, TX 75115-4712
(513) 502-8457
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
899470
TX
Other
Enumeration date
10/22/2017
Last updated
10/22/2017
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