Individual
PAULETTE R. X JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
741 E 104TH ST, CHICAGO, IL 60628-3018
(773) 750-2173
Mailing address
741 E 104TH ST, CHICAGO, IL 60628-3018
(773) 750-2173
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.301677
IL
Other
Enumeration date
03/28/2023
Last updated
03/28/2023
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