Provider Demographics
NPI:1356989735
Name:JACKSON, RHONITA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:RHONITA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10704 CALICO ASTER CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6346
Mailing Address - Country:US
Mailing Address - Phone:202-230-6211
Mailing Address - Fax:
Practice Address - Street 1:2127 RHODE ISLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2836
Practice Address - Country:US
Practice Address - Phone:202-269-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management