Healthcare Provider Details

I. General information

NPI: 1649710435
Provider Name (Legal Business Name): LINDSAY JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 WASHINGTON RD
PITTSBURGH PA
15228-2021
US

IV. Provider business mailing address

716 COMMERCIAL AVE SW
NEW PHILADELPHIA OH
44663-9367
US

V. Phone/Fax

Practice location:
  • Phone: 412-307-4609
  • Fax: 888-878-3824
Mailing address:
  • Phone: 330-343-7605
  • Fax: 330-343-3542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: