Individual
BERNADETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3420 BERTHA DR, BALDWIN, NY 11510-5052
(516) 223-2932
Mailing address
3420 BERTHA DR, BALDWIN, NY 11510-5052
(516) 223-2932
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
387144
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
387144
NYS NURSING LICENSE RN
NY
Enumeration date
02/22/2010
Last updated
02/22/2010
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