Provider Demographics
NPI:1730629742
Name:THOMAS-JACKSON, INGER (RN, BSN, LNC, IBCLC)
Entity type:Individual
Prefix:
First Name:INGER
Middle Name:
Last Name:THOMAS-JACKSON
Suffix:
Gender:F
Credentials:RN, BSN, LNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BOGUE RD
Mailing Address - Street 2:APT 148
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-9213
Mailing Address - Country:US
Mailing Address - Phone:530-777-3065
Mailing Address - Fax:
Practice Address - Street 1:700 BOGUE RD
Practice Address - Street 2:APT 148
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-9213
Practice Address - Country:US
Practice Address - Phone:530-777-3065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592107163WL0100X
LARN088016163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant