Individual
FOLASHADE AGNES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7330 SAN PEDRO AVE STE 800, SAN ANTONIO, TX 78216-6268
(210) 733-0524
Mailing address
16406 COLTS BAY, SELMA, TX 78154-3895
(240) 291-3145
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
309224
TX
Other
Enumeration date
02/21/2018
Last updated
02/21/2018
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