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Individual

CHANELL SHANNON JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NMW, WHNP

Contact information

Practice address
5883 1/2 DOVERWOOD DR, CULVER CITY, CA 90230-7203
(310) 848-7736
Mailing address
5883 1/2 DOVERWOOD DR, CULVER CITY, CA 90230-7203
(310) 848-7736

Taxonomy

Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
236061
CA
363LW0102X
Women's Health Nurse Practitioner
236061
CA

Other

Enumeration date
09/19/2021
Last updated
03/30/2022
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