Provider Demographics
NPI:1336953652
Name:JACKSON, AJALA
Entity type:Individual
Prefix:
First Name:AJALA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:JAQCKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3809 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1935
Mailing Address - Country:US
Mailing Address - Phone:402-466-4409
Mailing Address - Fax:402-475-6722
Practice Address - Street 1:3809 ADAMS ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-1935
Practice Address - Country:US
Practice Address - Phone:402-466-4409
Practice Address - Fax:402-475-6722
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider