Individual
ANNITTA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 400-4550
(574) 400-4551
Mailing address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 400-4550
(574) 400-4551
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27060852A
IN
Other
Enumeration date
04/17/2023
Last updated
04/17/2023
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