Provider Demographics
NPI:1255143228
Name:NADRANNE JACKSON LLC
Entity type:Organization
Organization Name:NADRANNE JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADRANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-360-8449
Mailing Address - Street 1:4204 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1310
Mailing Address - Country:US
Mailing Address - Phone:504-360-8449
Mailing Address - Fax:
Practice Address - Street 1:4111 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2202
Practice Address - Country:US
Practice Address - Phone:504-360-8449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty