Active NPI
Madeline Patricia Jackson, CNIM
- Electroneurodiagnostic Specialist/Technologist
- Canton, MI
National Provider Identifier
1407688583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Electroneurodiagnostic Specialist/Technologist
- Practice address
- 43754 Brandywyne Rd
Canton, MI 48187-2242 - Phone
- (586) 817-0671
- NPI assigned
- Aug 16, 2024
- 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 |
|---|---|---|---|---|
| Electroneurodiagnostic Specialist/Technologist | 246ZE0600X | Primary |
Addresses
Primary practice location
43754 Brandywyne Rd
Canton, MI 48187-2242
Mailing address
550 N Central Expy Unit 2586
McKinney, TX 75070-0139
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725753600000",
"number": "1407688583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 N CENTRAL EXPY UNIT 2586",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750700139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43754 BRANDYWYNE RD",
"city": "CANTON",
"state": "MI",
"postal_code": "481872242",
"telephone_number": "586-817-0671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MADELINE",
"middle_name": "PATRICIA",
"credential": "CNIM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-16",
"last_updated": "2024-09-08",
"certification_date": "2024-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "246ZE0600X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.