CANDICE LATRICE JACKSON

INDIANAPOLIS, IN
NPI1346705720
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: IN  71009203A)
Additional Taxonomies163WC0200X Registered Nurse, Critical Care Medicine
(Licence: IN  28209099A)
Enumeration Date2019-02-10
Last Update Date2023-04-27
Business Address
CANDICE LATRICE JACKSON
8325 E SOUTHPORT RD STE 100
INDIANAPOLIS, IN 46259-6834
Phone number: 317-862-6609
Mailing Address
CANDICE LATRICE JACKSON
PO BOX 781076
DETROIT, MI 48278-1076
Phone number: 317-528-4800