Individual
TOMIKISHA JENNIFER HACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8835 WHEELTON RD, ELK GROVE, CA 95624-5217
(916) 670-5162
Mailing address
PO BOX 941, ELK GROVE, CA 95759-0941
(916) 670-5162
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B7552244
CA
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
About Stedi
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