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1952174864 NPI number — MISS RODNESIA RENEE JACKSON

NPI Number: 1952174864
Health Care Provider/Practitioner: MISS RODNESIA RENEE JACKSON

Information about “1952174864” NPI (MISS RODNESIA RENEE JACKSON) exists in 1952174864 in HTML format HTML  |  1952174864 in plain Text format TXT  |  1952174864 in PDF (Portable Document Format) PDF  |  1952174864 in an XML format XML  formats.

NPI Number : 1952174864 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952174864",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "RODNESIA",
    "MiddleName": "RENEE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4212 HARBOR CRK",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BURTON",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48519-2843",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-230-0005",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4212 HARBOR CRK",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURTON",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48519-2843",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-230-0005",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/02/2023",
    "LastUpdateDate": "09/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "374J00000X",
          "TaxonomyName": "Doula",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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