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NPI Code Detail

MEDICARE: ERIN M JACKSON

MEDICARE: ERIN M 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
1225400000XRehabilitation Practitioner0801286001NV

General Provider Information

NPI Number : 1811285406
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN M JACKSON
Provider Business Mailing Address
First Line : 4865 PRADERA ST
Second Line :
City : SPARKS
State : NV
Zip : 89436-0676
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 480 GALLETTI WAY
Second Line : BLDG. 8B, 8C
City : SPARKS
State : NV
Zip : 89431-5564
Country : US
Telephone Number : 775-324-1490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2011
Last Update Date : 07/15/2011

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