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NPI Code Detail

MEDICARE: MRS. LINDA SWAN JACKSON RN MSN BC-FNP

MEDICARE: MRS. LINDA SWAN JACKSON RN MSN BC-FNP
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
1363LF0000XFamily Nurse Practitioner209002866IL

General Provider Information

NPI Number : 1629078910
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LINDA SWAN JACKSON RN MSN BC-FNP
Provider Business Mailing Address
First Line : 44 GENEVA AVE
Second Line :
City : BELLWOOD
State : IL
Zip : 60104-1101
Country : US
Telephone Number : 708-547-6931
Fax Number :
Provider Business Practice Location Address
First Line : 6748 W 111TH ST
Second Line :
City : WORTH
State : IL
Zip : 60482-1912
Country : US
Telephone Number : 708-361-9701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 02/11/2025

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