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1063840262
LATESHIA JACKSON
EASTON, MD
NPI
1063840262
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: MD R193593)
Enumeration Date
2013-10-24
Last Update Date
2019-09-18
Business Address
LATESHIA JACKSON
8737 BROOKS DR STE 108
EASTON, MD 21601-7474
Phone number: 800-867-2395
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Mailing Address
LATESHIA JACKSON
8142 HAROLD CT
GLEN BURNIE, MD 21061-4960
Phone number: 202-253-3588
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