Individual
BARBARA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
11 FAIRVIEW AVE, ISLIP TERRACE, NY 11752-2701
(631) 224-7808
Mailing address
11 FAIRVIEW AVE, ISLIP TERRACE, NY 11752-2701
(631) 224-7808
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
508534-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01973573
—
NY
Enumeration date
07/19/2007
Last updated
07/19/2007
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