Individual
GERMAINE RONKEITH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5555 BULLARD AVE, NEW ORLEANS, LA 70128-3450
(504) 240-2696
Mailing address
637 OAKWOOD DR, GRETNA, LA 70056-2932
(504) 729-0299
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20121157
LA
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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