Provider Demographics
NPI:1902441165
Name:AVRIL JACKSON, LPN, P.C.
Entity Type:Organization
Organization Name:AVRIL JACKSON, LPN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVRIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:914-682-2048
Mailing Address - Street 1:50 MAIN STREET STE 1000
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606
Mailing Address - Country:US
Mailing Address - Phone:914-682-2048
Mailing Address - Fax:914-682-7784
Practice Address - Street 1:50 MAIN ST STE 1000
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-1900
Practice Address - Country:US
Practice Address - Phone:914-682-2048
Practice Address - Fax:914-682-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty