Individual
MARLENA RENEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26967 CARLY DR, BROWNSTOWN, MI 48174-2539
(313) 205-6617
Mailing address
26967 CARLY DR, BROWNSTOWN, MI 48174-2539
(313) 205-6617
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
P655585734802
MI
Other
Enumeration date
08/24/2019
Last updated
08/24/2019
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