Provider Demographics
NPI:1770359879
Name:JACKSON, SONDRA ANNE (NC60519844)
Entity type:Individual
Prefix:
First Name:SONDRA
Middle Name:ANNE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NC60519844
Other - Prefix:
Other - First Name:SONDRA
Other - Middle Name:ANNE
Other - Last Name:GILKISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NC60519844
Mailing Address - Street 1:PO BOX 47877
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-7877
Mailing Address - Country:US
Mailing Address - Phone:360-236-4700
Mailing Address - Fax:
Practice Address - Street 1:3835 S 312TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2637
Practice Address - Country:US
Practice Address - Phone:206-779-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide