Individual
MELODY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
7224 PACIFIC HWY E, MILTON, WA 98354-9654
(253) 220-6183
Mailing address
13905 68TH AVENUE CT E, PUYALLUP, WA 98373-8723
(253) 640-4655
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60549994
WA
Other
Enumeration date
07/22/2022
Last updated
07/22/2022
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