Individual
TANYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7521 WESTBANK EXPY STE B, MARRERO, LA 70072-2300
(504) 391-3191
(504) 391-3193
Mailing address
7521 WESTBANK EXPY STE B, MARRERO, LA 70072-2300
(504) 391-3191
(504) 391-3193
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
LA
Other
Enumeration date
10/16/2006
Last updated
07/08/2007
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