Individual
MELANIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 W 5TH AVE, GARY, IN 46402-1723
(219) 885-4264
Mailing address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 885-4264
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
28276880A
IN
Other
Enumeration date
10/06/2022
Last updated
10/06/2022
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