Provider Demographics
NPI:1952026213
Name:JACKSON, SHARHONDA (RN)
Entity Type:Individual
Prefix:
First Name:SHARHONDA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 UNIVERSITY DR APT 1D
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6108
Mailing Address - Country:US
Mailing Address - Phone:125-252-5576
Mailing Address - Fax:
Practice Address - Street 1:4800 UNIVERSITY DR APT 1D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6108
Practice Address - Country:US
Practice Address - Phone:125-252-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC315740163W00000X
343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No163W00000XNursing Service ProvidersRegistered Nurse
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)