Provider Demographics
NPI:1275245201
Name:JACKSON, DEBORAH M (CARE GIVER)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5005
Mailing Address - Country:US
Mailing Address - Phone:937-830-9284
Mailing Address - Fax:
Practice Address - Street 1:1026 LEXINGTON AVE APT 30
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-5600
Practice Address - Country:US
Practice Address - Phone:937-830-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant