Nusha Sylaj Jackson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.021965 Issued in IL

Practice address

1656 N. Wells
Chicago, IL 60614-3224

Phone

(312) 643-1333

NPI assigned

Nov 19, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600214400000",
    "number": "1104462738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "939 W MADISON ST APT 307",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072657",
            "telephone_number": "248-770-5168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1656 N. WELLS",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143224",
            "telephone_number": "312-643-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NUSHA",
        "middle_name": "SYLAJ",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-19",
        "last_updated": "2020-09-16",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "IL",
            "license": "041434377",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.021965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martina Shauntae Jackson
• Matt Jackson, AGAC NP- BC
• Maudette M Jackson
• Morgan Elizabeth Jackson, MD
• Najla Jackson, APN
• Patricia Jackson, MFTI
• Paulette R. X Jackson, REGISTERED NURSE
• Philip Larkin Jackson III, M.D.
• Priscilla Lorraine Jackson, MHS, CADC
• Rachel Moore Jackson, APN

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.