Individual
DR. LASTASHA R JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
215 BULLENS LN, WOODLYN, PA 19094-2001
(484) 416-0769
Mailing address
330 E BROWN ST, NORRISTOWN, PA 19401-5407
(484) 213-3591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP022131
PA
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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