Wallace-Jackson, Shenikwa
Wallace-Jackson, Shenikwa is an individual health care provider with primary practice located at 177 Daffodil Dr Sw # D102 , Palm Bay FL 32908-3329. She recently has 2 registered licenses in different health care specialties including Nursing Service Related Providers / Homemaker, Nursing Service Related Providers / Home Health Aide. Nursing Service Related Providers / Home Health Aide is her primary health care specialty. Wallace-Jackson, Shenikwa can be contacted via phone (321) 223-2659.Contact Information
Primary practice address
177 Daffodil Dr Sw # D102
Palm Bay FL 32908-3329
Phone: (321) 223-2659
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Nursing Service Related Providers / Homemaker | 376J00000X | Florida | |
Nursing Service Related Providers / Home Health Aide | 374U00000X | Florida |
Profile Details
NPI number | 1598287187 |
---|---|
LBN Legal business name | Wallace-Jackson, Shenikwa |
Credentials | |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jul 14th, 2017 |
Last updated | Jul 21st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1598287187 | NPPES |
Florida | MEDICAID | 822161617 |
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