Provider Demographics
NPI:1528839941
Name:JACKSON, MANERA JESZEL (RN)
Entity type:Individual
Prefix:
First Name:MANERA
Middle Name:JESZEL
Last Name:JACKSON
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 1:5058 BURGUNDY LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5012
Mailing Address - Country:US
Mailing Address - Phone:714-905-2690
Mailing Address - Fax:
Practice Address - Street 1:5058 BURGUNDY LN
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-5012
Practice Address - Country:US
Practice Address - Phone:714-905-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802435163W00000X
IL041541710163W00000X
CA95047596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse