Provider Demographics
NPI:1811418981
Name:JACKSON, CHRISTINE ELIZABETH BURNS (CPNP, RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELIZABETH BURNS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CPNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11927 S AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-7346
Mailing Address - Country:US
Mailing Address - Phone:801-879-4808
Mailing Address - Fax:
Practice Address - Street 1:41 E 1140 N STE B
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045
Practice Address - Country:US
Practice Address - Phone:801-407-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9523223-4405363LP0200X
NY714498-1163W00000X
UT9523223-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse