Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000448 | CT |
NPI | 1144523390 |
---|---|
Provider Name | Dr. Shavon Leigh Jackson-Michel |
First Address | Bloomfield, NJ 07003-3924 |
Second Address | Bloomfield, NJ 07003-3924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2010 |
Last Update Date | 09/12/2010 |