Provider Demographics
NPI:1124259882
Name:JACKSON-MANU, JONELL (RN)
Entity type:Individual
Prefix:
First Name:JONELL
Middle Name:
Last Name:JACKSON-MANU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELGAR PL APT 13L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5064
Mailing Address - Country:US
Mailing Address - Phone:718-679-8350
Mailing Address - Fax:
Practice Address - Street 1:100 ELGAR PL APT 13L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5064
Practice Address - Country:US
Practice Address - Phone:718-679-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297316164W00000X
NY700611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse