CONCRAIGRETTA JACKSON


Address: 21124 Behrendt Ave, Warren, MI 48091-2774
Phone: 3137432278

CONCRAIGRETTA JACKSON (NPI# 1932741451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932741451
Entity Type Individual
Full Name CONCRAIGRETTA JACKSON
Practice Address 21124 Behrendt Ave
Warren
MI 48091-2774
Practice Telephone 3137432278
Enumeration Date 2019-10-16
Last Update Date 2019-10-16
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 164W00000X Licensed Practical Nurse 4703121283 MI Nursing Service Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
21124 Behrendt Ave, Warren, MI 480912774 3137432278

Office Location

Street Address 21124 BEHRENDT AVE
City WARREN
State MI
Zip Code 48091-2774

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1548615172 Amanda Lynn Kelsey Nurse Practitioner 21647 Ryan Road, Warren, MI 48091 2016-05-02
1902284474 Daejana Maldonado Licensed Practical Nurse 7519 Toepfer, Warren, MI 48091 2015-05-15
1245637743 Jerami Roy Recreation Therapist 7086 E 9 Mile, Warren, MI 48091 2014-11-26
1265698344 Amanda Sarah Yousif-mansour Dentist 2442 E 10 Mile Road, Warren, MI 48091 2008-07-29
1326171166 Sunshine Dental Center PC Dentist 21761 Ryan Rd, Warren, MI 48091 2007-03-13
1487709630 Albert Spickers General Practice 26193 Meredith Drive, Warren, MI 48091 2007-01-25
1487706859 Rita Jean Rose Physician Assistant 2104 E. 11 Mile Road, Suite 600, Warren, MI 48091 2007-01-17
1790835452 Cole Vision Corporation Eyewear Supplier (Equipment, not the service) 2000 Ten Mile Rd., Warren, MI 48091 2007-01-12
1942363759 Carolyn Joan Sucaet Physical Therapist 20952 12 Mile Road, Suite 110, St. Clair Shores, FM 48091 2006-12-19
1013070135 Mcnichols Xray Clinic PC Radiology 21230 Dequindre Road, Southeast Michigan Surgical Hospital, Warren, MI 48091 2006-12-19
Find all providers in zip 48091

Taxonomy Information

Taxonomy Code 164W00000X
Grouping Nursing Service Providers
Classification Licensed Practical Nurse

Taxonomy Definition

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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1437788536 Kathy Diane Garland Licensed Practical Nurse 3805 Lyntz Townline Rd Sw, Warren, OH 44481-9213 2020-04-02
1861026395 Bianca Symone-raveen Morris Licensed Practical Nurse 24629 Berry Ave, Warren, MI 48089-2170 2020-02-24
1417516170 Jasmin Marie Dahl Licensed Practical Nurse 159 Linden Ave Se, Warren, OH 44483-5921 2019-06-06
1043877368 Jamie Ryan Licensed Practical Nurse 687 Melwood Dr Ne, Warren, OH 44483-4437 2019-05-22
1164911244 Keenan Tenant Licensed Practical Nurse 28241 Gilbert Dr, Warren, MI 48093-2625 2018-05-04
1710474820 Courtney Mabins Licensed Practical Nurse 21135 La Salle Blvd, Warren, MI 48089-3414 2018-04-16
1003334889 Stephanie T Turuck Licensed Practical Nurse 1900 Sandpiper Trl Se, Warren, OH 44484-5712 2017-08-31
1790213650 Joyce A Mechling Licensed Practical Nurse 2737 Youngstown Rd., Warren, OH 44484 2017-05-23
1386178473 Theresa Mccoy Licensed Practical Nurse 13029 Georgiana Ave, Warren, MI 48089-3279 2017-04-14
1316488323 Ebone L Talley Licensed Practical Nurse 2779 Merriweather St Nw, Warren, OH 44485-2508 2017-03-10
Find all providers in WARREN

Competitor

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City WARREN
Zip Code 48091

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Dataset Information

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.

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