Individual
CYNTHIA DIANE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1315 CAMDEN WAY, UNIT B, WAUKESHA, WI 53186-6850
(262) 408-2606
Mailing address
1315 CAMDEN WAY, UNIT B, WAUKESHA, WI 53186-6850
(262) 408-2606
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
305199-31
WI
Other
Enumeration date
04/23/2012
Last updated
04/23/2012
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