Provider Demographics
NPI:1922375948
Name:JACKSON, NLEVEH NYAMAH (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NLEVEH
Middle Name:NYAMAH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2570
Mailing Address - Country:US
Mailing Address - Phone:978-710-7420
Mailing Address - Fax:
Practice Address - Street 1:31 CARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2570
Practice Address - Country:US
Practice Address - Phone:978-710-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN236799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse