Healthcare Provider Details

I. General information

NPI: 1407674898
Provider Name (Legal Business Name): LENORA JACKSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL PLZ
STAMFORD CT
06902-3602
US

IV. Provider business mailing address

1 HOSPITAL PLZ
STAMFORD CT
06902-3602
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-2695
  • Fax: 203-975-7842
Mailing address:
  • Phone: 203-276-2695
  • Fax: 203-975-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17211
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: