Individual
CHARTTISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2849 ELY AVE, UNIT 1, BRONX, NY 10469-6250
(347) 863-2187
Mailing address
2849 ELY AVE, UNIT 1, BRONX, NY 10469-6250
(347) 863-2187
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
314261
NY
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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