Individual
MACKENZIE CORY-RAE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2302 8TH ST N, FARGO, ND 58102-5022
(701) 200-4573
Mailing address
2302 8TH ST N, FARGO, ND 58102-5022
(701) 200-4573
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
07/01/2024
Last updated
07/01/2024
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