Provider Demographics
NPI:1376159533
Name:ROWBACK-JACKSON, SHERRY L
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:ROWBACK-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3859
Mailing Address - Country:US
Mailing Address - Phone:304-637-1000
Mailing Address - Fax:304-637-1025
Practice Address - Street 1:312 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3859
Practice Address - Country:US
Practice Address - Phone:304-637-1000
Practice Address - Fax:304-637-1025
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant