Individual
BREANNA J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
313 N 26TH ST, MATTOON, IL 61938-2556
(217) 480-5829
Mailing address
2601 CHAMPAIGN AVE, MATTOON, IL 61938-2548
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
209033792
IL
Other
Enumeration date
04/08/2026
Last updated
04/08/2026
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