Individual
GWENETTE JACKSON
Active
Individual
GWENETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
347C00000X
Private Vehicle
RT808274
OH
3747P1801X
Personal Care Attendant
—
OH
376J00000X
Homemaker
—
—
Other
Enumeration date
07/17/2014
Last updated
06/12/2024
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