Individual
GABRIELLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 CHERRY ST STE 11484, PHILADELPHIA, PA 19102-1312
(215) 255-7356
Mailing address
1601 CHERRY ST STE 11484, PHILADELPHIA, PA 19102-1312
(215) 255-7872
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN651718
PA
Other
Enumeration date
07/25/2018
Last updated
02/18/2019
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