Jackson, Glenda L
Jackson, Glenda L is an individual health care provider with primary practice located at 117 W Liberty Street , Rome NY 13440. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Jackson, Glenda L can be contacted via phone (315) 339-0401.Contact Information
Primary practice address
117 W Liberty Street
Rome NY 13440
Phone: (315) 339-0401
Fax: (315) 339-2957
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | F3340511 | New York |
Profile Details
| NPI number | 1134208119 |
|---|---|
| LBN Legal business name | Jackson, Glenda L |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 2nd, 2006 |
| Last updated | Mar 19th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134208119 | NPPES |
| New York | MEDICAID | 03353028 |
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