Most Relevant Information
Provider Data
| NPI Number: | 1003351255 |
| Provider Name: | ANDRECE JACKSON RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 240457-8 |
Most Important Dates
| Enumeration Date: | 12/27/2016 |
| Last Updated: | 12/27/2016 |
Provider Practice Location
167 NORTH MAIN STREET
TUBA CITY
AZ
860450600
Practice Location Phone/Fax
| Phone: | 9282832094 |
| Fax: | 9282832677 |
Provider Mailing Location
PO BOX 600
TUBA CITY
AZ
860450600
Provider Mailing Phone/Fax
| Phone: | 9282832094 |
| Fax: | 9282832677 |