Individual
MONICA N. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
707 N 190TH PLZ, ELKHORN, NE 68022-3974
(402) 815-6428
(402) 815-1565
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
59897
NE
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
111164
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025866100
—
NE
01
—
111164
APRN MEDICAL LICENSE
NE
05
—
1598078297
—
IA
Enumeration date
07/22/2010
Last updated
12/13/2013
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