Provider Demographics
NPI:1750160024
Name:JACKSON, NIESHA YOLANDA
Entity type:Individual
Prefix:
First Name:NIESHA
Middle Name:YOLANDA
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 1:817 IRVINGTON ST APT 201817
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2837
Mailing Address - Country:US
Mailing Address - Phone:240-346-2926
Mailing Address - Fax:
Practice Address - Street 1:817 IRVINGTON ST APT 201
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2837
Practice Address - Country:US
Practice Address - Phone:240-346-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant