Individual
ANITRA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3900 W CHARLESTON BLVD, STE 170, LAS VEGAS, NV 89102-1628
(702) 453-4673
Mailing address
3900 W CHARLESTON BLVD, STE 170, LAS VEGAS, NV 89102-1628
(702) 453-4673
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
09/28/2010
Last updated
12/10/2010
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