Individual
MACIA L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA, CNOR
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 298-4331
Mailing address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 298-4331
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
RN174620
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN174620
RN MEDICAL LICENSE
OH
Enumeration date
06/15/2009
Last updated
06/15/2009
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