Individual
SAMMIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1515 ASHTON DR, ROCHESTER HILLS, MI 48309-2251
(248) 710-4830
Mailing address
1515 ASHTON DR, ROCHESTER HILLS, MI 48309-2251
(248) 710-4830
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704427575
MI
164W00000X
Licensed Practical Nurse
Primary
4703109100
MI
171W00000X
Contractor
Primary
—
MI
Other
Enumeration date
08/02/2023
Last updated
02/26/2026
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