Individual
ANGELITA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
323 ANGELO DR, MONTGOMERY, NY 12549-1627
(914) 980-7802
Mailing address
323 ANGELO DR, MONTGOMERY, NY 12549-1627
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
290702
NY
Other
Enumeration date
12/06/2017
Last updated
12/06/2017
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