Individual
DOROTHY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9689 LYNNS RD, ETNA, OH 43062-8493
(614) 989-5996
Mailing address
9689 LYNNS RD, ETNA, OH 43062-8493
(614) 989-5996
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
314290
OH
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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