Individual
ANDREA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
52 HILLSIDE AVE, FREEPORT, NY 11520-1726
(516) 451-5257
Mailing address
52 HILLSIDE AVE, FREEPORT, NY 11520-1726
(516) 451-5257
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
258201
NY
Other
Enumeration date
11/27/2017
Last updated
11/27/2017
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