Provider Information for 1700116993
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Ms. ROSEANNE JOHNSON JACKSON
Other Names:Former Name:Ms. ROSEANNE LEE JOHNSONSex: Female
NPI: 1700116993
Last Updated: 2016-10-17
Certification Date:
Certification Date:
Details
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NPI | 1700116993 | ||||||||||||
Enumeration Date | 2010-01-11 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 2128 ELMWOOD AVE BUFFALO, NY 14207-1910 United States Phone: 716-874-4500 | Fax: | ||||||||||||
Primary Practice Address | 2128 ELMWOOD AVE BUFFALO, NY 14207-1910 United States Phone: 716-874-4500 | Fax: | ||||||||||||
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