Individual
RENEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
305 COLLEGE ST NE, LACEY, WA 98516-5390
(360) 412-4466
Mailing address
305 COLLEGE ST NE, LACEY, WA 98516-5390
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN00108453
WA
Other
Enumeration date
04/17/2014
Last updated
04/17/2014
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