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General NPI Number Information
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NPI Number | 1194372243
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Entity Type | Individual
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Provider Name | JOSHUA RASHAD JACKSON SR.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 6340 N 84TH ST APT 5
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City | MILWAUKEE
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State | WI
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Zip | 53225-1972
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Country | US
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Telephone | 414-233-5907
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Fax |
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Provider Business Mailing Address
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Address Line | N67W13215 DAYLILY DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-0504
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Country | US
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Telephone | 414-233-5907
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Fax | 262-345-5550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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