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General NPI Number Information
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NPI Number | 1912363458
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Entity Type | Individual
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Provider Name | JASON JACKSON C.P.T
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Gender | Male
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 4 E WEALD AVE
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City | BEAR
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State | DE
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Zip | 19701-1664
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Country | US
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Telephone | 302-230-1271
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Fax | 302-838-7034
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Provider Business Mailing Address
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Address Line | 19 W 24TH ST
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City | WILMINGTON
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State | DE
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Zip | 19802-4129
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Country | US
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Telephone | 302-230-1271
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Fax | 302-838-7034
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 20160113145
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License Number State | DE
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