Individual
JACQUELINE IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 STAMP RD STE 104, TEMPLE HILLS, MD 20748-6727
(202) 569-2990
Mailing address
4400 STAMP RD STE 104, TEMPLE HILLS, MD 20748-6727
(202) 569-2990
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
05/15/2017
Last updated
07/21/2022
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