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NPI Code Detail

MEDICARE: LINDA ELAINE JACKSON

MEDICARE: LINDA ELAINE JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse321977NY

General Provider Information

NPI Number : 1588330344
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA ELAINE JACKSON
Provider Business Mailing Address
First Line : 6016 FRESH POND RD
Second Line :
City : FLUSHING
State : NY
Zip : 11378-3454
Country : US
Telephone Number : 347-423-6972
Fax Number :
Provider Business Practice Location Address
First Line : 2901 216TH ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11360-2899
Country : US
Telephone Number : 718-281-8800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2021
Last Update Date : 08/20/2021

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Directions to “ LINDA ELAINE JACKSON ” Practice Location

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