Vesta Jackson

NPI 1083940217 - Licensed Practical Nurse - 164W00000X

NPI Details
NPI 1083940217
Gender Female
Enumeration Date 10/22/2009
Last Updated 10/22/2009
Entity Type Individual
Active Over 7 years ago
Practice Location
2626 E 46TH ST
STE J
INDIANAPOLIS IN, 46205-2380, US
Phone (317) 475-9066
Fax
Business Location
4749 AMESBURY PL
NOBLESVILLE IN, 46062-1104, US
Phone
Fax
Toxanomy
Taxonomy Code 164W00000X
License State Indiana
License Number 27059456A
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According to our database, Vesta Jackson NPI is 1083940217, taxonomy code is 164W00000X and license number is 27059456A, license state is located at Indiana. Vesta Jackson physically located at 2626 E 46th St, Indianapolis IN, 46205-2380. NPI Number Vesta Jackson has the Individual type.

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1083940217 NPI number is provided on an as is basis without warranty of any kind. 1083940217 is maintained by the National Plan & Provider Enumeration System. The contents of Vesta Jackson are for informational purposes only.