Provider Demographics
NPI:1255668430
Name:REED-JACKSON, LANITRA RENEE (LVN)
Entity Type:Individual
Prefix:MS
First Name:LANITRA
Middle Name:RENEE
Last Name:REED-JACKSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15728 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4225
Mailing Address - Country:US
Mailing Address - Phone:562-278-5103
Mailing Address - Fax:
Practice Address - Street 1:15728 SANTA ANA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4225
Practice Address - Country:US
Practice Address - Phone:562-278-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN186683164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse