Individual
SUSAN MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4805 MONTGOMERY RD STE 410, CINCINNATI, OH 45212
(513) 559-1222
(513) 559-1235
Mailing address
4805 MONTGOMERY RD STE 150, CINCINNATI, OH 45212-2280
(513) 961-5558
(513) 961-1912
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.259883-COA1
OH
363LA2200X
Adult Health Nurse Practitioner
1135253
KY
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP.13953
OH
Other
Enumeration date
02/21/2013
Last updated
05/17/2018
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