Provider Demographics
NPI:1326294224
Name:JACKSON-WOODS, LORENE CYNTHIA
Entity Type:Individual
Prefix:MS
First Name:LORENE
Middle Name:CYNTHIA
Last Name:JACKSON-WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORENE
Other - Middle Name:CYNTHIA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:6695 N SIERRA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-4856
Mailing Address - Country:US
Mailing Address - Phone:559-323-3885
Mailing Address - Fax:
Practice Address - Street 1:6695 N SIERRA VISTA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-4856
Practice Address - Country:US
Practice Address - Phone:559-323-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 116043164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse