Sandra Nicole Jackson M.D.

NPI 1063640563 - Pediatrics - 208000000X

NPI Details
NPI 1063640563
Gender Female
Enumeration Date 06/23/2009
Last Updated 08/27/2013
Entity Type Individual
Active Over 7 years ago
Practice Location
1653 W CONGRESS PKWY
CHICAGO IL, 60612-3833, US
Phone (312) 942-8000
Fax (312) 942-3551
Business Location
1653 W CONGRESS PKWY
CHICAGO IL, 60612-3833, US
Phone (312) 942-8000
Fax (312) 942-3551
Toxanomy
Taxonomy Code 208000000X
License State Illinois
License Number 336.091542
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According to our database, Dr. Sandra Nicole Jackson M.D. NPI is 1063640563, taxonomy code is 208000000X and license number is 336.091542, license state is located at Illinois. Sandra Nicole Jackson M.D. physically located at 1653 W Congress Pkwy, Chicago IL, 60612-3833. NPI Number Sandra Nicole Jackson M.D. has the Individual type.

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1063640563 NPI number is provided on an as is basis without warranty of any kind. 1063640563 is maintained by the National Plan & Provider Enumeration System. The contents of Sandra Nicole Jackson M.D. are for informational purposes only.