Healthcare Provider Details

I. General information

NPI: 1093892986
Provider Name (Legal Business Name): SUSAN SEARLE JACKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

7209 TIMBER LN
FALLS CHURCH VA
22046-2731
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-2250
  • Fax: 202-745-8629
Mailing address:
  • Phone: 202-745-2250
  • Fax: 202-745-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001060709
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001060709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: