Provider Demographics
NPI:1528569068
Name:JACKSON, DIONNA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIONNA
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 SWETLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1417
Mailing Address - Country:US
Mailing Address - Phone:216-640-3978
Mailing Address - Fax:
Practice Address - Street 1:4908 SWETLAND BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1417
Practice Address - Country:US
Practice Address - Phone:216-640-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156488164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse