Individual
MRS. GRACE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM LM
Contact information
Practice address
340 BRAKEFIELD ST, SLIDELL, LA 70458-3620
(985) 265-4032
Mailing address
340 BRAKEFIELD ST, SLIDELL, LA 70458-3620
(985) 265-4032
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
312612
LA
Other
Enumeration date
06/13/2019
Last updated
06/11/2024
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