Individual
TIFFANY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 WASHINGTON ST, MONROE, LA 71201-7046
(318) 325-8048
Mailing address
1705 WASHINGTON ST, MONROE, LA 71201-7046
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20102436
LA
Other
Enumeration date
11/14/2017
Last updated
11/14/2017
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