Individual
DIANNA M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
280 EXEMPLA CIR, LAFAYETTE, CO 80026-3370
(303) 861-3408
Mailing address
9251 HOOKER ST, WESTMINSTER, CO 80031-2726
(720) 890-7686
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015964
KAISER-COMMERCIAL NUMBER
—
Enumeration date
04/19/2007
Last updated
07/08/2007
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