Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ELLEN KIMBERLY JACKSON
Active Sole ProprietorELLEN KIMBERLY JACKSON is a Bus healthcare provider located in RIVERDALE, Illinois. NPI 1730353400 is currently active in the NPPES registry. Verify at CMS.
Bus · RIVERDALE, IL
Registration Details
- NPI Number
- 1730353400
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Apr 14, 2008 (18.332109553685 yrs)
- Last Updated
- Apr 14, 2008
- Sole Proprietor
- Yes
Practice Information
- Address
-
14122 S WABASH AVERIVERDALE, IL, 608272236Browse IL providers · Browse ZIP 60827
- Phone
- 7088419473
- Fax
- 7088800172
- Primary Specialty
-
Bus
343900000X
Other Bus Providers in RIVERDALE, IL
| Name | Credential | NPI |
|---|---|---|
| MS. MARIE JUDE SMITH | — | 1285186742 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.