Individual
DEBBIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12800 E WARREN AVE, DETROIT, MI 48215-2061
(313) 824-8000
(313) 824-5589
Mailing address
12800 E WARREN AVE, DETROIT, MI 48215-2061
(313) 824-8000
(313) 824-5589
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703108555
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4703108555
LPN LICENSE
MI
Enumeration date
12/10/2014
Last updated
12/10/2014
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