Individual
MRS. JACQUELINE DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
417 KENYON AVE, ELYRIA, OH 44035-6413
(440) 322-7644
Mailing address
417 KENYON AVE, ELYRIA, OH 44035-6413
(440) 322-7644
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN084359
OH
Other
Enumeration date
04/20/2006
Last updated
04/09/2008
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