Provider Demographics
NPI:1932458189
Name:ACKERSON, JEAN ALANNA (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ALANNA
Last Name:ACKERSON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 WATER STONE CIR
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-1419
Mailing Address - Country:US
Mailing Address - Phone:847-526-0006
Mailing Address - Fax:
Practice Address - Street 1:1247 WATER STONE CIR
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1419
Practice Address - Country:US
Practice Address - Phone:847-526-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-300122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse