Provider Demographics
NPI:1720439003
Name:JACKSON, SYLVIA
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:JACKSON
Suffix:
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 1:4147 W COURT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3568
Mailing Address - Country:US
Mailing Address - Phone:810-388-8402
Mailing Address - Fax:
Practice Address - Street 1:4147 W COURT ST
Practice Address - Street 2:APT 1
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3568
Practice Address - Country:US
Practice Address - Phone:810-388-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other