Provider Demographics
NPI:1356234132
Name:JACKSON, ZULTSETSEG WAGNER (PA-C)
Entity type:Individual
Prefix:
First Name:ZULTSETSEG
Middle Name:WAGNER
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ZOLA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:4600 SUNSET AVE
Mailing Address - Street 2:PHARMACY AND HEALTH SCIENCES BUILDING, ROOM 107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4600 SUNSET AVE
Practice Address - Street 2:PHARMACY AND HEALTH SCIENCES BUILDING, ROOM 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3443
Practice Address - Country:US
Practice Address - Phone:317-640-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant