Willa Samette Jackson, LPN
Individual provider Active NPI Licensed Practical Nurse · Clinton, OH
NPI 1982996245 · NPPES record last updated May 4, 2011
Key facts
- NPI
- 1982996245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- PN097350 (OH)
- Practice address
- 3067 Bronco Dr
Clinton, OH 44216-9736 - Phone
- (330) 825-0388
- NPI assigned
- May 4, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN097350 | OH | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN097350 | OH | Yes |
Addresses
Primary practice location
3067 Bronco Dr
Clinton, OH 44216-9736
Mailing address
3067 Bronco Dr
Clinton, OH 44216-9736
Phone (330) 825-0388
Other providers in Clinton, OH
- Nancy Elizabeth Harris
- Brandon Caleb Hart
- Connie Hawthorn
- Thomas Sherman Howard
- Adrian L Hummel
- Jordyn Taylor Laughlin
- Elizabeth Antwannette Little
- Robert Daniel Loper
- Rebecca E Miller
- ND Medical LLC
All providers in Clinton, OH · Licensed Practical Nurse in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.