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Individual

DAVID JOHN JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
4301 KITRIDGE RD, HUBER HEIGHTS, OH 45424-6022
(937) 681-6484
Mailing address
4301 KITRIDGE RD, HUBER HEIGHTS, OH 45424-6022
(937) 681-6484

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
140833
OH

Other

Enumeration date
08/31/2010
Last updated
08/31/2010
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