Individual
MS. MARY L. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3822 N 27TH ST, MILWAUKEE, WI 53216-2608
(414) 444-9235
Mailing address
3822 N 27TH ST, MILWAUKEE, WI 53216-2608
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34317031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39975900
PROVIDER NUMBER
WI
Enumeration date
03/21/2006
Last updated
02/29/2008
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