ELIZABETH DETWEILER JACKSON (NPI# 1902420466) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902420466 |
| Entity Type | Individual |
| Full Name | ELIZABETH DETWEILER JACKSON |
| Credential | APRN |
| Practice Address |
42 Town St Ste 300 Norwich CT 06360-2339 |
| Mailing Address |
110 Cooktown Rd Preston CT 06365-8801 |
| Practice Telephone | 8608860567 |
| Mailing Telephone | 8609173523 |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2020-08-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 132311 | CT | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
009070 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | CT LIC | 009070 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235743287 | Elizabeth Jane Jackson | Physical Therapist | 2241 Great Rock Rd, Vestavia Hills, AL 35216-2121 | 2020-09-06 |
| 1477018588 | Elizabeth C Jackson | Counselor | 13300 W 6th Ave # 22a, Lakewood, CO 80228-1255 | 2019-02-02 |
| 1619413861 | Elizabeth Marie Jackson | Nurse Practitioner | 123 Brooke Ln Ne, Cleveland, TN 37312-7416 | 2017-01-12 |
| 1699130245 | Elizabeth Grace Jackson | Counselor | Philhaven 283 Butler Road, Mt Gretna, PA 17064 | 2015-12-28 |
| 1649694233 | Elizabeth Arlene Jackson | Counselor | 922 12th St, Rawlins, WY 82301-6517 | 2014-02-18 |
| 1477882272 | Elizabeth Wood Jackson | Psychologist | 122 Saint Marys St, Raleigh, NC 27605-1809 | 2009-12-08 |
| 1104091784 | Elizabeth A Jackson | Specialist | 94 Auburn St Ste 106, Portland, ME 04103-2141 | 2008-04-24 |
| 1801095898 | Elizabeth Osborne Jackson | Dentist | 317 Rosewood St, Irondale, AL 35210-3116 | 2007-07-11 |
| 1295834893 | Elizabeth Marie Jackson | Physician Assistant | 515 Wekiva Commons Circle, Apopka, FL 32712 | 2006-09-21 |
| 1366078800 | Elizabeth Jackson | Counselor | 4902 S Cedar St, Lansing, MI 48910-5474 | 2020-03-17 |
| Street Address |
42 TOWN ST STE 300 |
| City | NORWICH |
| State | CT |
| Zip Code | 06360-2339 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326314154 | Corina Jane | Social Worker | 42 Town St Ste 300, Norwich, CT 06360-2339 | 2012-03-27 |
| 1013417849 | Laurie Giemza | Social Worker | 42 Town St Ste 300, Norwich, CT 06360-2339 | 2018-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417452 | Mafe Duyan Rato | Nurse Practitioner | 624 W West Main St, St 140, Norwich, CT 06360 | 2020-11-03 |
| 1255961561 | Holly M. Renstrom | Driver | 17 Annadell Rd, Norwich, CT 06360 | 2020-01-26 |
| 1609335397 | Chanel Justice | Social Worker | 2 Clinic Drive, Outpatient Clinic for Children, Norwich, CT 06360 | 2019-03-13 |
| 1457700189 | Michelle Pressler | Pharmacist | 634 West Main St, Norwich, CT 06360 | 2016-06-03 |
| 1265895726 | Katie Johnson | Social Worker | 18 Oneco Street, Norwich, CT 06360 | 2016-04-01 |
| 1871956623 | Lori Deslandes-paz | Pharmacist | 372 West Main Street, Norwich, CT 06360 | 2016-03-30 |
| 1336526193 | Keep An Open Mind, LLC | Marriage & Family Therapist | 12 Cass Street, Suite 202, Norwich, DC 06360 | 2015-04-30 |
| 1588084446 | Kinneri Kothari | Ophthalmology | 79 Wawecus St Ste 105, Norwich, CT 06360 | 2014-04-18 |
| 1962746537 | Robin B Smith | Social Worker | 401 W. Thames St, Bldg 301, Southeastern Mental Health Authority, Norwich, CT 06360 | 2012-11-20 |
| 1063766400 | Colleen Ellen Phillips-white | Social Worker | 401 West Thames St, Bldg 301, Southeastern Mental Health Authority, Norwich, CT 06360 | 2012-11-07 |
| Find all providers in zip 06360 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417452 | Mafe Duyan Rato | Nurse Practitioner | 624 W West Main St, St 140, Norwich, CT 06360 | 2020-11-03 |
| 1548812092 | Elizabeth Berthe Moore | Nurse Practitioner | 45 Hale St, Norwich, NY 13815-2038 | 2019-07-15 |
| 1487179818 | Allissa Kay Joseph | Nurse Practitioner | 330 Washington St Ste 510, Norwich, CT 06360-2733 | 2017-08-07 |
| 1982127460 | Catherine Ann Bernard | Nurse Practitioner | Po Box 1590, Norwich, VT 05055-1590 | 2017-07-17 |
| 1013456128 | Lydia Knapp | Nurse Practitioner | 9790 Mercer Rd, Norwich, OH 43767-9748 | 2017-02-22 |
| 1558817916 | Erika J Rossi | Nurse Practitioner | 55 Calvary Drive, Norwich, NY 13815 | 2016-08-26 |
| 1114102936 | Kate Elizabeth Van Arman | Nurse Practitioner | 130 Union Village Road, Norwich, VT 05055 | 2007-12-31 |
| 1932148194 | Anne M St Pierre | Nurse Practitioner | 157 E Main St, Norwich, NY 13815-1521 | 2006-06-05 |
| 1477167120 | Erin Apt | Nurse Practitioner | 47 Town St, Norwich, CT 06360-2323 | 2020-09-01 |
| 1558973610 | Ashley Lynn West | Nurse Practitioner | 47 Town St, Norwich, CT 06360-2323 | 2020-08-20 |
| Find all providers in NORWICH | ||||
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| 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.