Individual
MS. SHIRLEY JEAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
21 NORTH ATWOOD AVE, JANESVILLE, WI 53648
(608) 931-4477
Mailing address
13236 WYNSTONE WAY, ROCKTON, IL 61072-3254
(608) 931-4477
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39916200
—
WI
Enumeration date
01/10/2007
Last updated
03/19/2008
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