Provider Demographics
NPI:1134649833
Name:JACKSON, TRAMYRA YUETRICE I
Entity Type:Individual
Prefix:MISS
First Name:TRAMYRA
Middle Name:YUETRICE
Last Name:JACKSON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6695 SHULL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1222
Mailing Address - Country:US
Mailing Address - Phone:614-949-0463
Mailing Address - Fax:
Practice Address - Street 1:6695 SHULL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-1222
Practice Address - Country:US
Practice Address - Phone:614-949-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker