LATAVIA JACKSON

SHREVEPORT, LA
NPI1700536380
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy3747P1801X Technician, Personal Care Attendant
(Licence: LA  2203782259)
Enumeration Date2022-03-25
Last Update Date2022-03-25
Business Address
LATAVIA JACKSON
264 WICHITA ST
SHREVEPORT, LA 71101-4932
Phone number: 318-254-3193
Mailing Address
LATAVIA JACKSON
264 WICHITA ST
SHREVEPORT, LA 71101-4932
Phone number: 318-254-3193