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1700536380
LATAVIA JACKSON
SHREVEPORT, LA
NPI
1700536380
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
(Licence: LA 2203782259)
Enumeration Date
2022-03-25
Last Update Date
2022-03-25
Business Address
LATAVIA JACKSON
264 WICHITA ST
SHREVEPORT, LA 71101-4932
Phone number: 318-254-3193
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Mailing Address
LATAVIA JACKSON
264 WICHITA ST
SHREVEPORT, LA 71101-4932
Phone number: 318-254-3193
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