Provider Demographics
NPI:1538983556
Name:JACKSON, DAWN C
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:C
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 BEULAH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3211
Mailing Address - Country:US
Mailing Address - Phone:234-340-9137
Mailing Address - Fax:
Practice Address - Street 1:4341 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:PENINSULA
Practice Address - State:OH
Practice Address - Zip Code:44264-9637
Practice Address - Country:US
Practice Address - Phone:232-340-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant