Provider Demographics
NPI:1407107048
Name:XAVIER, JACKSON (NURSE)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:XAVIER
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2113
Mailing Address - Country:US
Mailing Address - Phone:978-473-1216
Mailing Address - Fax:
Practice Address - Street 1:60 LOWELL ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2113
Practice Address - Country:US
Practice Address - Phone:978-473-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse