Individual
WANDA MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 GENERAL DE GAULLE DR, NEW ORLEANS, LA 70114-6632
(504) 620-3130
Mailing address
312 E 3RD ST, BELLE CHASSE, LA 70037-2809
(504) 377-7242
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
292534
LA
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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