Individual
KATRINA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3944 N 11TH ST, MILWAUKEE, WI 53206-3058
(414) 837-0199
Mailing address
3944 N 11TH ST, MILWAUKEE, WI 53206-3058
(414) 837-0199
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
J2505178870303
WI
Other
Enumeration date
10/02/2025
Last updated
10/02/2025
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