Provider Demographics
NPI:1992958128
Name:JACKSON, CHRISTINE E (FNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:E
Other - Last Name:VENCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:477 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5036
Mailing Address - Country:US
Mailing Address - Phone:978-837-5441
Mailing Address - Fax:978-837-5557
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8900
Practice Address - Fax:978-557-8856
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000927201Medicare PIN