Wanda Marie Jackson
Licensed Practical Nurse in New Orleans, LA. Individual provider (NPI-1).
NPI number1982194635
StatusActive
Last updated in NPPESMay 17, 2018
Details
- NPI
- 1982194635
- Entity type
- Individual (NPI-1)
- Name
- Wanda Marie Jackson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 17, 2018
- Last updated
- May 17, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 292534 | LA | Yes |
Practice location
3100 General De Gaulle DrNew Orleans, LA 70114-6632
Phone 504-620-3130
Mailing address
312 E 3rd StBelle Chasse, LA 70037-2809
Phone 504-377-7242
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