Individual
MS. KATHLEEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
7702 W THURSTON AVE, MILWAUKEE, WI 53218
(414) 438-6534
(414) 438-6534
Mailing address
7702 W THURSTON AVE, MILWAUKEE, WI 53218
(414) 438-6534
(414) 438-6534
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
84084030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39966400
—
WI
Enumeration date
09/20/2006
Last updated
07/09/2007
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