Provider Demographics
NPI:1821392648
Name:JACKSON, RACHEL M
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4151
Mailing Address - Country:US
Mailing Address - Phone:610-504-0016
Mailing Address - Fax:
Practice Address - Street 1:842 N 17TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4151
Practice Address - Country:US
Practice Address - Phone:610-504-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
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No376J00000XNursing Service Related ProvidersHomemaker