1629078910 NPI number — MRS. LINDA SWAN JACKSON RN MSN BC-FNP

Table of content: MRS. LINDA SWAN JACKSON RN MSN BC-FNP (NPI 1629078910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629078910 NPI number — MRS. LINDA SWAN JACKSON RN MSN BC-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
LINDA
Provider Middle Name:
SWAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN MSN BC-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWAN
Provider Other First Name:
LINDA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629078910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 GENEVA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60104-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-547-6931
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6748 W 111TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORTH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60482-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-361-9701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2005

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: 363LF0000X , with the licence number:  209002866 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com