Individual
STEPHANIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4080 E LAKE MEAD BLVD STE B111, LAS VEGAS, NV 89115-6466
(702) 531-9344
Mailing address
4080 E LAKE MEAD BLVD STE B111, LAS VEGAS, NV 89115-6466
(702) 531-9344
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9195864430
—
NV
Enumeration date
05/17/2022
Last updated
05/17/2022
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