Provider Demographics
NPI:1043776404
Name:JACKSON, SARAH LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 FOREST MILLS RD
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-7574
Mailing Address - Country:US
Mailing Address - Phone:563-794-0662
Mailing Address - Fax:
Practice Address - Street 1:985 FOREST MILLS RD
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-7574
Practice Address - Country:US
Practice Address - Phone:563-794-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse