Individual
ASHLEY ROCHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6321 NEW UTRECHT AVE FL 2, BROOKLYN, NY 11219-5425
(212) 687-7464
(718) 799-1049
Mailing address
10416 223RD ST, QUEENS VILLAGE, NY 11429-2157
(347) 293-3119
(718) 799-1049
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
655416
NY
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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