Individual
TRACY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4101 W ILES AVE, SPRINGFIELD, IL 62711-7051
(217) 993-7085
Mailing address
5964 MILLS BOTTOM RD, SHIPMAN, IL 62685-6729
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.392089
IL
Other
Enumeration date
06/23/2021
Last updated
06/23/2021
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