Individual
MS. ROSA LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
547 SUMMIT AVE, BALDWIN, NY 11510-3725
(516) 546-2674
Mailing address
547 SUMMIT AVE, BALDWIN, NY 11510-3725
(516) 546-2674
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
200042
NY
Other
Enumeration date
09/09/2008
Last updated
09/09/2008
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