Active NPI
Laquanta Jackson
- Registered Nurse
- Olympia Fields, IL
National Provider Identifier
1194372953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041317085
- Practice address
- 2430 Athens Rd
Olympia Fields, IL 60461-1954 - Phone
- (708) 790-0366
- Fax
- (708) 844-0264
- NPI assigned
- Aug 26, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041317085 | IL | Primary |
Addresses
Primary practice location
2430 Athens Rd
Olympia Fields, IL 60461-1954
Mailing address
2430 Athens Rd
Olympia Fields, IL 60461-1954
Phone (708) 790-0366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041317085 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1194372953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2430 ATHENS RD",
"city": "OLYMPIA FIELDS",
"state": "IL",
"postal_code": "604611954",
"telephone_number": "708-790-0366",
"fax_number": "708-844-0264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2430 ATHENS RD",
"city": "OLYMPIA FIELDS",
"state": "IL",
"postal_code": "604611954",
"telephone_number": "708-790-0366",
"fax_number": "708-844-0264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "LAQUANTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-26",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041317085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia Fields, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.