National Provider Identifier
Wytasha Jackson, LPN
Wytasha Jackson, LPN is listed in the NPPES registry with a primary specialty of Licensed Practical Nurse in Webster, NY and a listed phone number of (315) 398-3702.
Profile Overview
- NPI
- 1750726881
- Provider Type
- Individual
- Primary Specialty
- Licensed Practical Nurse
- Enumeration Date
- May 02, 2013
- Last Updated
- May 02, 2013
Practice Location
- 173 Country Manor Way
- Webster, NY 14580-3376
Phone: (315) 398-3702
Specialties
- Licensed Practical Nurse (164W00000X)
Full Record
- NPI
- 1750726881
- Entity Type
- Individual
- Last Name
- Jackson
- First Name
- Wytasha
- Credential
- LPN
- Mailing Street Address
- 173 Country Manor Way
- Mailing City
- Webster
- Mailing State
- NY
- Mailing ZIP Code
- 14580-3376
- Mailing Country
- US
- Mailing Phone
- (315) 398-3702
- Practice Street Address
- 173 Country Manor Way
- Practice City
- Webster
- Practice State
- NY
- Practice ZIP Code
- 14580-3376
- Practice Country
- US
- Practice Phone
- (315) 398-3702
- Enumeration Date
- May 02, 2013
- Last Updated
- May 02, 2013
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Licensed Practical Nurse (164W00000X)