Norma M Jackson, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.007090 Issued in IL

Practice address

650 Warrenville Rd
Suite 400
Lisle, IL 60532-4314

Phone

(214) 681-2376

Fax

(855) 589-8353

NPI assigned

Aug 7, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optum Care Services Company

  • Family Nurse Practitioner
  • Columbia, MD
  • NPI 1912199415
  NPD (past)

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457481600000",
    "number": "1477744183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 WARRENVILLE RD",
            "address_2": "SUITE 400",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605324314",
            "telephone_number": "214-681-2376",
            "fax_number": "855-589-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 WARRENVILLE RD",
            "address_2": "SUITE 400",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605324314",
            "telephone_number": "214-681-2376",
            "fax_number": "855-589-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NORMA",
        "middle_name": "M",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2016-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP008804",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.007090",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP123742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrity Anesthesia Management LLC
• International Translation Support Services Inc.
• Intranerve LLC
• Emily Isaacson, PA
• Jackson Healthcare Systems
• Janet Jakova, LPC
• James L Derrico DDS
• Valerie Janson
• Richard W Jaros, RPH
• Jeanelle Marchese DMD, LTD

• Family Nurse Practitioner in Lisle, IL
• Providers in Lisle, 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 Mar 9, 2016; 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.