Healthcare Provider Details

I. General information

NPI: 1952026213
Provider Name (Legal Business Name): SHARHONDA JACKSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 UNIVERSITY DR APT 1D
DURHAM NC
27707-6108
US

IV. Provider business mailing address

4800 UNIVERSITY DR APT 1D
DURHAM NC
27707-6108
US

V. Phone/Fax

Practice location:
  • Phone: 125-252-5576
  • Fax:
Mailing address:
  • Phone: 125-252-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number315740
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: