Provider Demographics
NPI:1487964474
Name:JACKSON-NIX, SYLVIA (STNA)
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:
Last Name:JACKSON-NIX
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10911 MORISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3268
Mailing Address - Country:US
Mailing Address - Phone:216-394-1024
Mailing Address - Fax:
Practice Address - Street 1:10911 MORISON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3268
Practice Address - Country:US
Practice Address - Phone:216-394-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379128240201376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide