Provider Demographics
NPI:1346497153
Name:JACKSON, ROLONDA S (RN, PHN)
Entity Type:Individual
Prefix:
First Name:ROLONDA
Middle Name:S
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HOPYARD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-7101
Mailing Address - Country:US
Mailing Address - Phone:925-233-4727
Mailing Address - Fax:
Practice Address - Street 1:4900 HOPYARD RD STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-7101
Practice Address - Country:US
Practice Address - Phone:925-233-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse