Individual
PRISCILLA LYNETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AIDE
Contact information
Practice address
1718 S HEIGHTS AVE, YOUNGSTOWN, OH 44502-2946
(330) 788-3152
Mailing address
1718 S HEIGHTS AVE, YOUNGSTOWN, OH 44502-2946
(330) 788-3152
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
322277300102
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2973466
—
OH
Enumeration date
10/22/2009
Last updated
10/22/2009
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