Charlene Rene Jackson

NPI #1487105458 in Eastpointe, Michigan

Provider Information

NPI Number: 1487105458
Entity Type: Individual
Name: Charlene Rene Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Oct 14, 2016
Last Updated: Oct 14, 2016

Practice Location

Address: 18029 STEPHENS DR
City: Eastpointe
State: Michigan
ZIP Code: 48021-1810
Phone: (586) 209-9161

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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