Individual
DEBORAH L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1163 COUNTRY CLUB ROAD, MONONGAHELA, PA 15063-1095
(724) 258-1085
(724) 258-1394
Mailing address
1163 COUNTRY CLUB ROAD, MONONGAHELA, PA 15063-1095
(724) 258-1085
(724) 258-1394
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN186507L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217541
UPMC
PA
01
—
JA706895
BLUE SHIELD
PA
Enumeration date
10/11/2006
Last updated
07/09/2007
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