1659444594 NPI number — MRS. CHERIE JEANINE DAVIS-JACKSON R.N. MSN FNP

Table of content: MRS. CHERIE JEANINE DAVIS-JACKSON R.N. MSN FNP (NPI 1659444594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659444594 NPI number — MRS. CHERIE JEANINE DAVIS-JACKSON R.N. MSN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS-JACKSON
Provider First Name:
CHERIE
Provider Middle Name:
JEANINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N. MSN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
CHERIE
Provider Other Middle Name:
JEANINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N. MSN FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659444594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14745 GUADALUPE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO MURIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95683-9438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-354-0743
Provider Business Mailing Address Fax Number:
916-354-1732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7001-A EAST PARKWAY
Provider Second Line Business Practice Location Address:
PUBLIC HLTH SERVICES-ADMIN. STE. # 500
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-875-5701
Provider Business Practice Location Address Fax Number:
916-875-6366
Provider Enumeration Date:
11/16/2006

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:  252206 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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