Individual
TAWANNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3824 CEDAR SPRINGS RD, DALLAS, TX 75219-4136
(214) 555-1111
Mailing address
3824 CEDAR SPRINGS RD, DALLAS, TX 75219-4136
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
110587
TX
Other
Enumeration date
11/07/2008
Last updated
11/13/2014
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