Individual
VERA LORRAINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3905 WHITE AVE, BALTIMORE, MD 21206
(443) 325-6600
Mailing address
3905 WHITE AVE, BALTIMORE, MD 21206
(443) 325-6600
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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