Provider Demographics
NPI:1376769489
Name:JACKSON, JANELL ANN (RN)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:ANN
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 1:5148 CORONADO SCHOOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650
Mailing Address - Country:US
Mailing Address - Phone:520-378-0616
Mailing Address - Fax:
Practice Address - Street 1:5148 S CORONADO SCHOOL DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9075
Practice Address - Country:US
Practice Address - Phone:520-378-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079312163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool