NPI 1336742469

Angela Jackson

Practitioner Prosthetist Waldorf, MD

Practice location

Address: 2164 Bonnie Ln, Waldorf, MD 20601-3902
Phone: (202) 748-1632
Mailing address: 173 Saint Patricks Dr STE 195, Waldorf, MD 20603-5529

Registered specialties

Prosthetist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224P00000X Licence 231822 (MD)

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Registry record

NPI: 1336742469
Entity type: Individual
Sex (as registered): Female
NPI issued: 20 Nov 2020
Record last updated: 18 Jun 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.