Individual
VICTORIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
920 LAURA ST, BOWMAN, SC 29018-8612
(803) 354-1011
Mailing address
PO BOX 643, BOWMAN, SC 29018-0643
(803) 354-1011
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
100078
SC
163WH0500X
Hemodialysis Registered Nurse
Primary
100078
SC
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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