1801877907 NPI number — MS. PAULA DEAUN JACKSON MSN

Table of content: MS. PAULA DEAUN JACKSON MSN (NPI 1801877907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801877907 NPI number — MS. PAULA DEAUN JACKSON MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
PAULA
Provider Middle Name:
DEAUN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
PAULA
Provider Other Middle Name:
DEAUN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, CRNP, LNC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801877907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13579
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19612-3579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-628-1324
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 E ERIE AVE
Provider Second Line Business Practice Location Address:
SUITE 3311
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-3871
Provider Business Practice Location Address Fax Number:
215-492-8119
Provider Enumeration Date:
11/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LC1500X , with the licence number:  26NJ00025500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: TP004745D , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)