Loreal Lanique Jackson
Chore Provider in Omaha, NE. Individual provider (NPI-1).
NPI number1295542215
StatusActive
Last updated in NPPESDec 12, 2024
Details
- NPI
- 1295542215
- Entity type
- Individual (NPI-1)
- Name
- Loreal Lanique Jackson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 12, 2024
- Certification date
- Dec 12, 2024
- Last updated
- Dec 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 372500000X | Chore Provider | – | – | Yes |
Practice location
4803 N 80th AveOmaha, NE 68134-3228
Phone 402-403-8704
Mailing address
4803 N 80th AveOmaha, NE 68134-3228
Phone 402-403-8704
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