Individual
MAUREEN KHADIJA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1510 HOGAN CT, CONCORD, NC 28025-0240
(716) 228-3266
Mailing address
1510 HOGAN CT, CONCORD, NC 28025-0240
(716) 228-3266
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
28634
NC
164W00000X
Licensed Practical Nurse
311952
NY
Other
Enumeration date
02/14/2013
Last updated
02/14/2013
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