Individual
BRENDA ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 LAKE TRAVERSE DR, SISSETON, SD 57262-7046
(605) 698-7606
Mailing address
PO BOX 651, AGENCY VILLAGE, SD 57262-0651
(605) 698-7606
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
—
—
Other
Enumeration date
05/28/2009
Last updated
05/28/2009
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