Individual
MR. SHANON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9205 WESTERN AVE APT 222, OMAHA, NE 68114-2294
(402) 515-2603
Mailing address
9205 WESTERN AVE APT 222, OMAHA, NE 68114-2294
(402) 515-2603
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
NE
3747P1801X
Personal Care Attendant
—
NE
Other
Enumeration date
05/07/2025
Last updated
09/23/2025
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