Individual
MISS PREATA LENAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
17016 JURASSIC PL, VICTORVILLE, CA 92394-7723
(760) 596-1033
(760) 596-1033
Mailing address
17016 JURASSIC PL, VICTORVILLE, CA 92394-7723
(760) 596-1033
(760) 596-1033
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
Primary
704221
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
704221
CALIFORNIA BOARD OF NURSING
CA
Enumeration date
10/21/2008
Last updated
10/21/2008
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