CANDICE LATRICE JACKSON

INDIANAPOLIS, IN
NPI1346705720
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: IN  71009203A)
Additional Taxonomies363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: IN  71009203B)
Enumeration Date2019-02-10
Last Update Date2024-07-03
Business Address
CANDICE LATRICE JACKSON
6025 WILDCAT DR
INDIANAPOLIS, IN 46203-5751
Phone number: 317-493-6456
Mailing Address
CANDICE LATRICE JACKSON
6025 WILDCAT DR
INDIANAPOLIS, IN 46203-5751
Phone number: 317-493-6456