Individual
ROBERT JOSEPH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
5454 EAST STATE ST, HERMITAGE, PA 16148
(724) 346-2123
(724) 346-0366
Mailing address
PO BOX 1027, 5454 EAST STATE STREET, HERMITAGE, PA 16148-0027
(724) 346-2123
(724) 346-0366
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN270387
PA
Other
Enumeration date
07/11/2011
Last updated
07/11/2011
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