IndividualActive
Angela Jackson
NPI 1336742469 · Prosthetist · Waldorf, MD
Provider details
- NPI number
- 1336742469
- Entity type
- Individual
- Primary specialty
- ProsthetistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 231822 (MD)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
2164 Bonnie Ln
Waldorf, MD 20601-3902
Phone: (202) 748-1632
Approximate (ZIP-level) locationGet directions
Mailing address
173 Saint Patricks Dr Ste 195
Waldorf, MD 20603-5529
Registry dates
- Enumerated
- 2020-11-20
- Last updated
- 2024-06-18
- Certified
- 2024-06-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.