Provider Demographics
NPI:1730483983
Name:JACKSON, DARLENE SHAMARA (RN)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:SHAMARA
Last Name:JACKSON
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 1:135 CHESTNUT LN
Mailing Address - Street 2:306-J
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1041
Mailing Address - Country:US
Mailing Address - Phone:216-224-9224
Mailing Address - Fax:
Practice Address - Street 1:135 CHESTNUT LN
Practice Address - Street 2:306-J
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1041
Practice Address - Country:US
Practice Address - Phone:216-224-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126907146N00000X
OHRN.356658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic