Individual
SHANTE OCTAVIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
50 E WILLOW GROVE AVE APT 1, PHILA, PA 19118-3464
(856) 514-0073
Mailing address
50 E WILLOW GROVE AVE APT 1, PHILA, PA 19118-3464
(856) 514-0073
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
LPN303611
PA
Other
Enumeration date
07/07/2025
Last updated
07/07/2025
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