MEDICARE: ANGELA WENDY JACKSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	163WC0400X	Case Management Registered Nurse	522012	TX

General Provider Information

NPI Number	:	1659619328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WENDY JACKSON RN

Provider Business Mailing Address
First Line	:	8299 CAMBRIDGE
Second Line	:	1602
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	713-826-8476
Fax Number	:

Provider Business Practice Location Address
First Line	:	8299 CAMBRIDGE ST
Second Line	:	1602
City	:	HOUSTON
State	:	TX
Zip	:	77054-3170
Country	:	US
Telephone Number	:	713-826-8476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	07/09/2013

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