Provider Demographics
NPI:1003679762
Name:JACKSON, RACHEL ALEXA (RN)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ALEXA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ALEXA
Other - Last Name:HARISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8608
Mailing Address - Country:US
Mailing Address - Phone:845-705-3563
Mailing Address - Fax:
Practice Address - Street 1:100 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4641
Practice Address - Country:US
Practice Address - Phone:845-621-6600
Practice Address - Fax:845-628-0644
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY773251163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool