Healthcare Provider Details

I. General information

NPI: 1043145683
Provider Name (Legal Business Name): SHEILA LOUISE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7059 CROWN POINT AVE APT 117
OMAHA NE
68104-5310
US

IV. Provider business mailing address

7059 CROWN POINT AVE APT 117
OMAHA NE
68104-5310
US

V. Phone/Fax

Practice location:
  • Phone: 402-515-4049
  • Fax:
Mailing address:
  • Phone: 402-515-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberG01304821
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: