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General NPI Number Information
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NPI Number | 1649848896
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Entity Type | Individual
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Provider Name | AMY CHRISTINE JACKSON
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 8401 MARKET ST
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City | BOARDMAN
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State | OH
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Zip | 44512-6725
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Country | US
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Telephone | 330-729-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 405 PARKVIEW DR
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City | COLUMBIANA
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State | OH
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Zip | 44408-1158
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Country | US
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Telephone | 330-477-0975
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | APRN.CNP.0029080
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License Number State | OH
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