Individual
KATELYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
424 SAVANNAH RD, LEWES, DE 19958-1462
(419) 356-4784
Mailing address
5370 ADELLA ST, TOLEDO, OH 43613-2779
(419) 356-4784
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2308512
MA
163W00000X
Registered Nurse
Primary
371288
OH
163W00000X
Registered Nurse
9424562
FL
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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