Provider Demographics
NPI:1336802412
Name:JACKSON, NANCY CHERI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CHERI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 CAMPO RD STE 270
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1490
Mailing Address - Country:US
Mailing Address - Phone:619-465-4982
Mailing Address - Fax:
Practice Address - Street 1:9735 CAMPO RD STE 270
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1490
Practice Address - Country:US
Practice Address - Phone:619-465-4982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA714784163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse