Individual
SHANAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4285 N RANCHO DR STE 160, LAS VEGAS, NV 89130-3456
(702) 835-1922
Mailing address
3435 W CRAIG RD STE C, NORTH LAS VEGAS, NV 89032-5116
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
374U00000X
Home Health Aide
1306384219
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306384219
—
NV
Enumeration date
06/09/2021
Last updated
02/14/2025
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