Provider Demographics
NPI:1720759889
Name:JACKSON, ALIZAY DANAY
Entity Type:Individual
Prefix:
First Name:ALIZAY
Middle Name:DANAY
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 1:675 HANCOCK AVE APT A5
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-1051
Mailing Address - Country:US
Mailing Address - Phone:330-606-8568
Mailing Address - Fax:
Practice Address - Street 1:675 HANCOCK AVE APT A5
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-1051
Practice Address - Country:US
Practice Address - Phone:330-606-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health