Provider Demographics
NPI:1407182785
Name:JACKMAN, CHRISTINE LYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LYN
Last Name:JACKMAN
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 1:24 SUSSEX CT W
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9779
Mailing Address - Country:US
Mailing Address - Phone:419-512-6291
Mailing Address - Fax:
Practice Address - Street 1:24 SUSSEX CT W
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-9779
Practice Address - Country:US
Practice Address - Phone:419-512-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN351683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse