Provider Demographics
NPI:1003489618
Name:JACKSON, EMMALINE SUE
Entity Type:Individual
Prefix:
First Name:EMMALINE
Middle Name:SUE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTANA STATE UNIVERSITY COLLEGE OF NURSING
Mailing Address - Street 2:1500 UNIVERSITY DRIVE
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-994-3597
Mailing Address - Fax:
Practice Address - Street 1:MONTANA STATE UNIVERSITY COLLEGE OF NURSING
Practice Address - Street 2:1500 UNIVERSITY DRIVE
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-994-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program