Active NPI
Deja Jackson
- Nurse's Aide
- Lorain, OH
National Provider Identifier
1699182279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 41118080710
- Practice address
- 2529 Reeves Ave
F6
Lorain, OH 44052-4279 - Phone
- (440) 654-9561
- NPI assigned
- Jul 16, 2014
- 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 |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 41118080710 | OH | Primary |
Addresses
Primary practice location
2529 Reeves Ave
F6
Lorain, OH 44052-4279
Mailing address
2529 Reeves Ave
F6
Lorain, OH 44052-4279
Phone (440) 654-9561
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 |
|---|---|---|---|
| 41118080710 | OH | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1699182279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2529 REEVES AVE",
"address_2": "F6",
"city": "LORAIN",
"state": "OH",
"postal_code": "440524279",
"telephone_number": "440-654-9561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2529 REEVES AVE",
"address_2": "F6",
"city": "LORAIN",
"state": "OH",
"postal_code": "440524279",
"telephone_number": "440-654-9561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEJA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-07-16",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "OH",
"license": "41118080710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.