MEDICARE: MS. ANGEL A 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
1	372500000X	Chore Provider
2	372500000X	Chore Provider		NV

General Provider Information

NPI Number	:	1245999218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGEL A JACKSON

Provider Business Mailing Address
First Line	:	9526 MICHELLE FALLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3727
Country	:	US
Telephone Number	:	702-772-6904
Fax Number	:

Provider Business Practice Location Address
First Line	:	9526 MICHELLE FALLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3727
Country	:	US
Telephone Number	:	702-773-5654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	12/16/2021

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Directions to “ MS. ANGEL A JACKSON ” Practice Location

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