Individual
BIANCHA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHSC, RD
Contact information
Practice address
5201 HAVERFORD AVE, PHILADELPHIA, PA 19139-1401
(215) 471-2761
Mailing address
7 DUMONT CT, LAWRENCEVILLE, NJ 08648-1334
(609) 902-0156
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86096975
—
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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