Individual
AMANDA NICOLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
923 COTTAGE AVE, MIAMISBURG, OH 45342-1805
(937) 716-6219
Mailing address
923 COTTAGE AVE, MIAMISBURG, OH 45342-1805
(937) 716-6219
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.144284-M-IV
OH
Other
Enumeration date
03/01/2013
Last updated
03/01/2013
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