Provider Demographics
NPI:1962606319
Name:JACKSON, JANET A (CRNP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 LEISZS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2325
Mailing Address - Country:US
Mailing Address - Phone:484-269-7656
Mailing Address - Fax:
Practice Address - Street 1:301 PENN AVE
Practice Address - Street 2:#200
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1128
Practice Address - Country:US
Practice Address - Phone:610-372-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004468D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics