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NPI Code Detail

MEDICARE: MRS. URSULA L JACKSON FNP-BC

MEDICARE: MRS. URSULA L JACKSON FNP-BC
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
1363LF0000XFamily Nurse PractitionerCNP-019895OH

General Provider Information

NPI Number : 1942758032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. URSULA L JACKSON FNP-BC
Provider Business Mailing Address
First Line : 13944 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3804
Country : US
Telephone Number : 216-767-4274
Fax Number :
Provider Business Practice Location Address
First Line : 13944 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-3804
Country : US
Telephone Number : 216-767-4274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2016
Last Update Date : 02/05/2018

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