Willie Mae Jackson

NPI 1043312960 - Dietetic Technician, Registered - 136A00000X

NPI Details
NPI 1043312960
Gender Female
Enumeration Date 09/01/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
820 S DAMEN AVE
CHICAGO IL, 60612-3728, US
Phone (312) 569-3565
Fax (312) 569-6118
Business Location
820 S DAMEN AVE
CHICAGO IL, 60612-3728, US
Phone (312) 569-3565
Fax (312) 569-6118
Toxanomy
Taxonomy Code 136A00000X
License State
License Number
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According to our database, Willie Mae Jackson NPI is 1043312960, taxonomy code is 136A00000X Willie Mae Jackson physically located at 820 S Damen Ave, Chicago IL, 60612-3728. NPI Number Willie Mae Jackson has the Individual type.

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1043312960 NPI number is provided on an as is basis without warranty of any kind. 1043312960 is maintained by the National Plan & Provider Enumeration System. The contents of Willie Mae Jackson are for informational purposes only.