Provider Demographics
NPI:1013010941
Name:JACKSON, LINDA OLIN (RN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:OLIN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:109 BEE ST
Mailing Address - Street 2:112-A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-5789
Mailing Address - Country:US
Mailing Address - Phone:843-789-7345
Mailing Address - Fax:843-789-6264
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:112-A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-789-7345
Practice Address - Fax:843-789-6264
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC2403363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health