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NPI Code Detail

MEDICARE: MS. QIANA JACKSON

MEDICARE: MS. QIANA JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374J00000XDoula

General Provider Information

NPI Number : 1194468405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. QIANA JACKSON
Provider Business Mailing Address
First Line : 630 GRAND ST
Second Line :
City : TRENTON
State : NJ
Zip : 08610-6427
Country : US
Telephone Number : 609-851-3733
Fax Number :
Provider Business Practice Location Address
First Line : 16 W FRONT ST
Second Line :
City : TRENTON
State : NJ
Zip : 08608-2010
Country : US
Telephone Number : 609-851-3373
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2022
Last Update Date : 04/14/2022

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Directions to “ MS. QIANA JACKSON ” Practice Location

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