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General NPI Number Information
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NPI Number | 1255143228
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Entity Type | Organization
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Legal Business Name | NADRANNE JACKSON LLC
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 4111 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70065-2202
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Country | US
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Telephone | 504-360-8449
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Fax |
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Provider Business Mailing Address
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Address Line | 4204 ARIZONA AVE
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City | KENNER
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State | LA
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Zip | 70065-1310
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Country | US
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Telephone | 504-360-8449
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Fax |
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Authorized Official
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Title or Position | OWNER MASSAGE THERAPIST
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Name | MRS. NADRANNE L JACKSON
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Credential |
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Telephone | 504-360-8449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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