Individual
CANDICE RENEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2 TUCKAHOE CT, 308, FAIRFIELD, OH 45014-4321
(513) 477-3793
Mailing address
2 TUCKAHOE CT, 308, FAIRFIELD, OH 45014-4321
(513) 477-3793
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 133146
OH
Other
Enumeration date
11/03/2010
Last updated
11/03/2010
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