Individual
DEJA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2529 REEVES AVE, F6, LORAIN, OH 44052-4279
(440) 654-9561
Mailing address
2529 REEVES AVE, F6, LORAIN, OH 44052-4279
(440) 654-9561
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
41118080710
OH
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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