Individual
MS. SHATONNE DIANNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
616 ELLSWORTH DR, DAYTON, OH 45426
(937) 581-5081
Mailing address
616 ELLSWORTHY DR, DAYTON, OH 45426
(937) 581-5081
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
149943
OH
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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