Individual
MAIA J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2266 W WALTON BLVD, WATERFORD, MI 48329-4430
(248) 513-5657
Mailing address
2266 W WALTON BLVD, WATERFORD, MI 48329-4430
(248) 513-5657
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703091783
MI
Other
Enumeration date
08/06/2024
Last updated
08/06/2024
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