Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LONGVIEW AVE
WHITE PLAINS NY
10601-5000
US

IV. Provider business mailing address

2 LONGVIEW AVE
WHITE PLAINS NY
10601-5000
US

V. Phone/Fax

Practice location:
  • Phone: 914-849-7600
  • Fax:
Mailing address:
  • Phone: 914-849-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: