Individual
QIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15565 NORTHLAND DR SUITE 604WEST, SOUTHFIELD, MI 48075
(313) 213-6723
Mailing address
15927 BRAMELL ST, DETROIT, MI 48223-1058
(313) 522-4283
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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