Healthcare Provider Details

I. General information

NPI: 1659444594
Provider Name (Legal Business Name): CHERIE JEANINE DAVIS-JACKSON R.N. MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERIE JEANINE DAVIS R.N. MSN FNP

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001-A EAST PARKWAY PUBLIC HLTH SERVICES-ADMIN. STE. # 500
SACRAMENTO CA
95823-2034
US

IV. Provider business mailing address

14745 GUADALUPE DR
RANCHO MURIETA CA
95683-9438
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-5701
  • Fax: 916-875-6366
Mailing address:
  • Phone: 916-354-0743
  • Fax: 916-354-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number252206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: