Healthcare Provider Details

I. General information

NPI: 1356453096
Provider Name (Legal Business Name): MARCIA J JACKSON-HOOPER RN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 17TH ST NE
WASHINGTON DC
20002
US

IV. Provider business mailing address

801 17TH ST NE
WASHINGTON DC
20002
US

V. Phone/Fax

Practice location:
  • Phone: 202-398-5520
  • Fax: 202-396-6953
Mailing address:
  • Phone: 202-398-5520
  • Fax: 202-396-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN27649
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: