Individual
BRIAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1680 WALDEN AVE, CHEEKTOWAGA, NY 14225-4914
(716) 894-7777
Mailing address
1680 WALDEN AVE, CHEEKTOWAGA, NY 14225-4914
(716) 894-7777
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
398422-1
NY
363LF0000X
Family Nurse Practitioner
332648
NY
Other
Enumeration date
01/04/2017
Last updated
01/04/2017
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