Healthcare Provider Details

I. General information

NPI: 1962396358
Provider Name (Legal Business Name): HANNAH NICOLE JACKSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W CHAMBERS ST
MILWAUKEE WI
53210-1650
US

IV. Provider business mailing address

5000 W CHAMBERS ST
MILWAUKEE WI
53210-1650
US

V. Phone/Fax

Practice location:
  • Phone: 414-527-8191
  • Fax:
Mailing address:
  • Phone: 414-527-8191
  • Fax: 414-465-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO10698
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number102019-851
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: