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Individual

EMILY LYNN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
30736 HOOVER RD, WARREN, MI 48093-2555
(734) 927-5225
Mailing address
9151 BUTWELL ST, LIVONIA, MI 48150-3439
(734) 233-7722

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009550
MI

Other

Enumeration date
10/22/2019
Last updated
10/22/2019
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