Healthcare Provider Details

I. General information

NPI: 1891218152
Provider Name (Legal Business Name): JOANN JACKSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANN M JACKSON CRNP

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ANDERSON ST STE 101
PITTSBURGH PA
15212-5803
US

IV. Provider business mailing address

381 44TH ST
PITTSBURGH PA
15201-1711
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-4151
  • Fax:
Mailing address:
  • Phone: 412-370-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017804
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: