Individual
RUTH A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 576-4904
(586) 573-5953
Mailing address
47650 BARBARA RD, MACOMB, MI 48044-2410
(248) 259-1768
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704330240
MI
Other
Enumeration date
04/18/2022
Last updated
04/06/2026
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