Individual
MRS. ALISHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1650 MIDTOWN RD, PERU, IL 61354-1200
(815) 220-2645
Mailing address
235 POUNDSTONE AVE, PO BOX 42, GRAND RIDGE, IL 61325-9100
(815) 236-0024
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.015095
IL
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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