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General NPI Number Information
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NPI Number | 1477744183
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Entity Type | Individual
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Provider Name | NORMA M JACKSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 650 WARRENVILLE RD SUITE 400
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City | LISLE
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State | IL
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Zip | 60532-4314
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Country | US
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Telephone | 214-681-2376
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Fax | 855-589-8353
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Provider Business Mailing Address
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Address Line | 650 WARRENVILLE RD SUITE 400
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City | LISLE
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State | IL
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Zip | 60532-4314
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Country | US
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Telephone | 214-681-2376
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Fax | 855-589-8353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP008804
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.007090
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP123742
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License Number State | TX
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