Individual
LATANYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PBT
Taxonomy
Speciality
Code
Description
License number
State
246R00000X
Pathology Technician
Primary
67093
TN
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
Update your record
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