Provider Demographics
NPI:1497032387
Name:JACKSON, JANET (EAMP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:YODER
Mailing Address - State:KS
Mailing Address - Zip Code:67585-0045
Mailing Address - Country:US
Mailing Address - Phone:408-455-8415
Mailing Address - Fax:
Practice Address - Street 1:5 MORGAN HWY STE 4
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-253-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60248749171100000X
CA14562171100000X
PAKO000657171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist