Provider Demographics
NPI:1639226558
Name:JACKSON FELICIANO, NORMA (RN)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:
Last Name:JACKSON FELICIANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1259
Mailing Address - Country:US
Mailing Address - Phone:973-790-9455
Mailing Address - Fax:973-790-9432
Practice Address - Street 1:888 E 24TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513-1424
Practice Address - Country:US
Practice Address - Phone:973-519-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO70158163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis