Individual
TASIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
522 S MAPLE RD, ANN ARBOR, MI 48103-3837
(734) 585-7970
Mailing address
522 S MAPLE RD, ANN ARBOR, MI 48103-3837
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703109319
MI
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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