Individual
ANNIEKA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
860 MELROSE AVE, BRONX, NY 10451-4443
(917) 473-6996
Mailing address
815 OCEAN AVE APT 1B, BROOKLYN, NY 11226-5945
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
722776
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
JAC-87-8257
—
ND
Enumeration date
01/16/2020
Last updated
01/16/2020
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