Individual
MRS. ANGELA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2164 BONNIE LN, WALDORF, MD 20601-3902
(202) 748-1632
Mailing address
173 SAINT PATRICKS DR STE 195, WALDORF, MD 20603-5529
(833) 764-3634
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
231822
MD
Other
Enumeration date
11/20/2020
Last updated
06/18/2024
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