Individual
DIANA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
6628 CRESCENT GRN, WEST BLOOMFIELD, MI 48322-1325
(248) 592-9803
Mailing address
6628 CRESCENT GRN, WEST BLOOMFIELD, MI 48322-1325
(248) 592-9803
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703092206
MI
Other
Enumeration date
07/06/2009
Last updated
07/06/2009
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