Individual
SUMMER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
531 LINDEN AVE, BELLWOOD, IL 60104-1854
(773) 416-9936
Mailing address
531 LINDEN AVE, BELLWOOD, IL 60104-1854
(773) 416-9936
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2000357580
IL
363L00000X
Nurse Practitioner
Primary
209025419
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000357580
—
IL
Enumeration date
03/03/2022
Last updated
03/15/2025
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