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General NPI Number Information
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NPI Number | 1629078910
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Entity Type | Individual
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Provider Name | LINDA SWAN JACKSON RN MSN BC-FNP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 6748 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482-1912
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Country | US
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Telephone | 708-361-9701
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Fax |
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Provider Business Mailing Address
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Address Line | 44 GENEVA AVE
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City | BELLWOOD
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State | IL
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Zip | 60104-1101
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Country | US
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Telephone | 708-547-6931
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Fax |
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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 | 209002866
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License Number State | IL
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