Provider Demographics
NPI:1629078910
Name:JACKSON, LINDA SWAN (RN MSN BC-FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SWAN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN MSN BC-FNP
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:44 GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-1101
Mailing Address - Country:US
Mailing Address - Phone:708-547-6931
Mailing Address - Fax:
Practice Address - Street 1:11200 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8208
Practice Address - Country:US
Practice Address - Phone:815-464-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily