Provider Demographics
NPI:1831462282
Name:JACKSON, DIONNE RAYSHELLE
Entity Type:Individual
Prefix:MS
First Name:DIONNE
Middle Name:RAYSHELLE
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 1:6400 CENTER ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4115
Mailing Address - Country:US
Mailing Address - Phone:440-382-9377
Mailing Address - Fax:
Practice Address - Street 1:6400 CENTER ST
Practice Address - Street 2:UNIT 6
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4115
Practice Address - Country:US
Practice Address - Phone:440-382-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide