Most Relevant Information
Provider Data
| NPI Number: | 1003536707 |
| Provider Name: | SANDRA JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 374U00000X |
| Specialty: | Home Health Aide |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/01/2022 |
| Last Updated: | 09/01/2022 |
Provider Practice Location
4513 PINE KNOLL DR
SHREVEPORT
LA
711072605
Practice Location Phone/Fax
| Phone: | 3186178095 |
| Fax: |
Provider Mailing Location
4513 PINE KNOLL DR
SHREVEPORT
LA
711072605
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |