Individual
MS. GRACE E JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5400 LEES CROSSING DR APT 4, CINCINNATI, OH 45239-7656
(513) 432-0624
Mailing address
5400 LEES CROSSING DR APT 4, CINCINNATI, OH 45239-7656
(513) 432-0624
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN125325
OH
Other
Enumeration date
03/15/2010
Last updated
03/15/2010
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