Provider Demographics
NPI:1619719895
Name:JACKSON, SARAH MURTHA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MURTHA
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 1:329 WYOGA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1109
Mailing Address - Country:US
Mailing Address - Phone:440-387-3640
Mailing Address - Fax:
Practice Address - Street 1:3567 RESERVE COMMONS DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5323
Practice Address - Country:US
Practice Address - Phone:330-536-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.466805163W00000X
OHAPRN.CNP.0036855363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health