Individual
CYNETHIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4131 BASSWOOD DR, GOSHEN, IN 46526-8154
(574) 320-0728
Mailing address
4131 BASSWOOD DR, GOSHEN, IN 46526-8154
(574) 320-0728
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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