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NPI Code Detail

MEDICARE: GRETA OLIVIA JACKSON

MEDICARE: GRETA OLIVIA 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
1106S00000XBehavior TechnicianRBT-23-268576TX

General Provider Information

NPI Number : 1730935594
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRETA OLIVIA JACKSON
Provider Business Mailing Address
First Line : 33043 EGYPT LN
Second Line :
City : MAGNOLIA
State : TX
Zip : 77354-2480
Country : US
Telephone Number : 281-894-1423
Fax Number :
Provider Business Practice Location Address
First Line : 33043 EGYPT LN
Second Line :
City : MAGNOLIA
State : TX
Zip : 77354-2480
Country : US
Telephone Number : 281-894-1423
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2024
Last Update Date : 04/24/2024

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Directions to “ GRETA OLIVIA JACKSON ” Practice Location

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