Individual
CARMELLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
916 SCHOOL AVE, MATTESON, IL 60443-1832
(773) 941-1587
Mailing address
916 SCHOOL AVE, MATTESON, IL 60443-1832
(773) 941-1587
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209020232
IL
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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