Individual
WANDA JACKSON BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
555 STOCKTON ST, JACKSONVILLE, FL 32204-2534
(904) 387-4661
Mailing address
555 STOCKTON ST, JACKSONVILLE, FL 32204-2534
(904) 387-4661
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
312051
FL
164W00000X
Licensed Practical Nurse
Primary
312051
FL
Other
Enumeration date
07/01/2022
Last updated
07/01/2022
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