Individual
REGINA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
650 HEATHER RIDGE DR UNIT L, FREDERICK, MD 21702-8814
(240) 656-8166
Mailing address
650 HEATHER RIDGE DR UNIT L, FREDERICK, MD 21702-8814
(240) 656-8166
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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