Individual
ADRIENNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 PINE DR, HAMMOND, LA 70401-1411
(985) 634-8235
Mailing address
103 PINE DR, HAMMOND, LA 70401-1411
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20131008
LA
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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