MS. SERIDA MARIE JACKSON (NPI# 1154841120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154841120 |
| Entity Type | Individual |
| Full Name | MS. SERIDA MARIE JACKSON |
| Credential | LPN |
| Practice Address |
106 Countisbury Ave Valley Stream NY 11580-1748 |
| Practice Telephone | (516) 270-0943 |
| Mailing Telephone | 5162700943 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2017-06-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | 328081 | NY | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 124742419 | 05 |
| Street Address |
106 COUNTISBURY AVE |
| City | VALLEY STREAM |
| State | NY |
| Zip Code | 11580-1748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807276 | Jason Diana Lmsw | Clinic/Center | 50 West Hawthorne Ave 2nd Floor, Valley Stream, NY 11580 | 2020-10-09 |
| 1346853033 | R.l. Physical Therapy | Physical Therapist | 1676 Putney Road, Valley Stream, NY 11580 | 2020-08-24 |
| 1427523869 | Jessica Doyle | Social Worker | 5-11 Pflug Pl, Valley Stream, NY 11580 | 2018-10-12 |
| 1013491026 | Syeda Afshan Firdous | Licensed Practical Nurse | 13 Cleaveland St, Valley Stream, NY 11580 | 2018-09-17 |
| 1700377934 | Jisha Merin Mathew | Nurse Practitioner | 1835 Oliver Ave, Apt 4, Valley Stream, NY 11580 | 2018-05-23 |
| 1669970273 | Terrice Bell | Social Worker | 50 W Hawthorne Avenue, Valley Streams, NY 11580 | 2018-01-29 |
| 1659883718 | Rita M. Fowler | Registered Nurse | 33 West Hawthorne Ave. Suite 31, New York Health Care, Valley Stream, NY 11580 | 2017-10-30 |
| 1881104768 | Sharon Stephenson | Peer Specialist | 51 Foster Avenue, North Valley Stream, Valley Stream, NY 11580 | 2017-10-05 |
| 1356850200 | Barry Henderson | Case Manager/Care Coordinator | 23 Marlow Road, Valley Stream, NY 11580 | 2017-09-22 |
| 1922526565 | Aneta Kaczmarski | Physical Therapy Assistant | 299 North Corona Ave, Valley Stream, NY 11580 | 2017-09-05 |
| Find all providers in zip 11580 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295373769 | Lisa Mcfaddin-robinson | Licensed Practical Nurse | 40 Liberty Blvd, Valley Stream, NY 11580-4834 | 2019-12-16 |
| 1437792579 | Shellon Pryce | Licensed Practical Nurse | 106 E Beverly Pkwy, Valley Stream, NY 11580-4238 | 2019-10-22 |
| 1477104016 | Yoldie Francois | Licensed Practical Nurse | 44 Spring Garden St, Valley Stream, NY 11580-3523 | 2019-09-25 |
| 1952872681 | Samanta Boursiquot | Licensed Practical Nurse | 7 Bismark Ave, Valley Stream, NY 11581-1455 | 2018-12-06 |
| 1013491026 | Syeda Afshan Firdous | Licensed Practical Nurse | 13 Cleaveland St, Valley Stream, NY 11580 | 2018-09-17 |
| 1194206292 | Pierre Monsanto | Licensed Practical Nurse | 1300 Barry Dr S, Valley Stream, NY 11580-1542 | 2018-08-27 |
| 1477031953 | Evris Shepard | Licensed Practical Nurse | 136 Roberta St, Valley Stream, NY 11580-2724 | 2018-08-06 |
| 1962997692 | Julia Hannah Gbondo | Licensed Practical Nurse | 159 Carroll Ave, Valley Stream, NY 11580-2977 | 2018-06-25 |
| 1184134595 | Davon Franklin | Licensed Practical Nurse | 1835 Oliver Ave Apt 1, Valley Stream, NY 11580-1603 | 2017-10-11 |
| 1821508995 | Shanil Bahadur | Licensed Practical Nurse | 39 Ivanhoe Pl, Valley Stream, NY 11580-2901 | 2017-10-03 |
| Find all providers in VALLEY STREAM | ||||
| City | VALLEY STREAM |
| Zip Code | 11580 |
Please comment or provide details below to improve the information on MS. SERIDA MARIE JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.