Individual
SHAMIKA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2213 CHESHIRE DR, AURORA, IL 60502-6938
(773) 595-7828
Mailing address
2213 CHESHIRE DR, AURORA, IL 60502-6938
(773) 595-7828
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
823160557
—
IL
Enumeration date
08/31/2021
Last updated
08/31/2021
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