Individual
TIA MARIANA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2264 CENTER CT N APT 3, GRAND ISLAND, NY 14072-1745
(716) 495-6980
Mailing address
31 AZURE PINE CT, BUFFALO, NY 14228-1872
(716) 495-6980
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Enumeration date
04/30/2022
Last updated
02/17/2023
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