Provider Demographics
NPI:1881885028
Name:JACKSON, KATHERINE JEAN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEAN
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 1:17 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MA
Mailing Address - Zip Code:01929-1409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 ADDISON ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MA
Practice Address - Zip Code:01929-1409
Practice Address - Country:US
Practice Address - Phone:978-768-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care