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Individual

COLLEEN A JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
101 HOSPITAL RD, PATCHOGUE, NY 11772-4870
(631) 654-7236
Mailing address
101 HOSPITAL RD, PATCHOGUE, NY 11772-4870

Taxonomy

Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
004661
NY

Other

Enumeration date
08/26/2008
Last updated
08/26/2008
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