Active NPI
Preata Lenae Jackson, RN
- Maternal Newborn Registered Nurse
- Victorville, CA
National Provider Identifier
1912159047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Maternal Newborn Registered Nurse
- License
- 704221
- Practice address
- 17016 Jurassic PL
Victorville, CA 92394-7723 - Phone
- (760) 596-1033
- Fax
- (760) 596-1033
- NPI assigned
- Oct 21, 2008
- Last updated
- Oct 21, 2008
- 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 |
|---|---|---|---|---|
| Maternal Newborn Registered Nurse | 163WM0102X | 704221 | CA | Primary |
Addresses
Primary practice location
17016 Jurassic PL
Victorville, CA 92394-7723
Mailing address
17016 Jurassic PL
Victorville, CA 92394-7723
Phone (760) 596-1033
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 704221 | Other | CA | CALIFORNIA BOARD OF NURSING |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 704221 | CA | MD | Maternal Newborn Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224547200000",
"number": "1912159047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17016 JURASSIC PL",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923947723",
"telephone_number": "760-596-1033",
"fax_number": "760-596-1033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17016 JURASSIC PL",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923947723",
"telephone_number": "760-596-1033",
"fax_number": "760-596-1033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PREATA",
"middle_name": "LENAE",
"name_prefix": "Miss",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-21",
"last_updated": "2008-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0102X",
"taxonomy_group": "",
"desc": "Registered Nurse, Maternal Newborn",
"state": "CA",
"license": "704221",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA BOARD OF NURSING",
"identifier": "704221",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.