MRS. EDNA RUTH JACKSON (NPI# 1114097870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114097870 |
| Entity Type | Individual |
| Full Name | MRS. EDNA RUTH JACKSON |
| Credential | RN |
| Practice Address |
2395 W Grand Blvd Detroit MI 48208-1210 |
| Mailing Address |
18001 Saint Marys St Detroit MI 48235-3176 |
| Practice Telephone | 3138972061 |
| Mailing Telephone | 3132724034 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WA2000X |
Registered Nurse Specialization: Administrator |
4704118498 | MI | Nursing Service Providers |
| Street Address |
2395 W GRAND BLVD |
| City | DETROIT |
| State | MI |
| Zip Code | 48208-1210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992709331 | Professional Plaza Clinic Corporation | Legal Medicine | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2005-06-13 |
| 1184808966 | Ann Davis Garvin | Advanced Practice Midwife | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2007-12-28 |
| 1316088644 | Lisa Marie Randon | Pediatrics | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2007-02-09 |
| 1043369929 | David Alton Aprahamian | Family Medicine | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2007-01-09 |
| 1871695312 | Betty Ann Dornbrook | Nurse Practitioner | 2395 W Grand Blvd, Detroit, MI 48208-1210 | 2006-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616554 | Henry Ford Health System | Pharmacy | 2800 W Grand Blvd, Detroit, MI 48208 | 2020-10-16 |
| 1932645405 | Diane Louise Dodson | Counselor | 5500 Trumbull Apt 315, Detroit, MI 48208 | 2017-01-09 |
| 1164881306 | Cory Eugene Martin | Counselor | 1852 W. Grand Blvd., Detroit, MI 48208 | 2016-02-16 |
| 1578947784 | Hamza Belhaj | Dentist | 2700 Martin Luther King Jr Blvd, Detroit, MI 48208 | 2015-07-17 |
| 1942629167 | Diana Pool | Counselor | 3737 Lawton, Detroit, MI 48208 | 2014-04-15 |
| 1124467048 | Aisha Williams | Social Worker | 4707 Vinewood St., Detroit, MI 48208 | 2013-06-25 |
| 1295079895 | Mia Love | Nurse Practitioner | 2959 Martin Luther King Jr Blvd, Detroit, MI 48208 | 2012-11-20 |
| 1992064356 | Valarie Egeria Foulks | Counselor | 2051 W. Grand Blvd, Detroit, MI 48208 | 2012-05-04 |
| 1023304078 | Ayana Njeri Davis | Massage Therapist | 2550 W. Grand Blvd, Detroit, MI 48208 | 2011-06-28 |
| 1184922627 | Shar Inc. | Community Based Residential Treatment Facility, Mental Illness | 1852 W.grand Blvd, Detroit, MI 48208 | 2011-03-08 |
| Find all providers in zip 48208 | ||||
| Taxonomy Code | 163WA2000X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Administrator |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679697650 | Wilhelmina Keeling | Registered Nurse | 5400 East Seven Mile, Detroit Health Dept. - Northeast Health Center, Detroit, MI 48234 | 2007-03-16 |
| 1427182252 | Marjorie Anita Harris | Registered Nurse | 14585 Greenfield Road, Detroit Health Dept. - Grace Ross Health Center, Detroit, MI 48227 | 2007-03-15 |
| 1326481755 | Tracy Wallace | Registered Nurse | 15400 W Mcnichols Rd, Detroit, MI 48235-3724 | 2013-04-16 |
| 1194849943 | Katie Beatric Randolph | Registered Nurse | 1151 Taylor St, Detroit Health Dept. - Herman Kiefer Health Complex, Detroit, MI 48202-1732 | 2007-03-19 |
| 1386795755 | Patricia Ann Soares | Registered Nurse | 4777 E Outer Dr, Detroit, MI 48234-3241 | 2007-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427602531 | Jackie Lavete Lucas | Registered Nurse | 19270 Red Maple Ct, Southfield, MI 48076-1006 | 2019-07-26 |
| 1194385930 | Cheryl L Schneider | Registered Nurse | 1200 Ransom St Ste 201, Muskegon, MI 49442-3344 | 2019-06-14 |
| 1891354502 | Marcia A Regalado | Registered Nurse | 11208 Kennebec Ave, Allen Park, MI 48101-1008 | 2019-06-07 |
| 1184289019 | Lena Faling | Registered Nurse | 3200 Horton Rd, Jackson, MI 49203-5549 | 2019-05-06 |
| 1558869180 | Aster Care LLC | Registered Nurse | 1015 Henrietta St, Birmingham, MI 48009-4112 | 2018-01-29 |
| 1295263929 | Karen Ann Zambiasi | Registered Nurse | 2425 S Linden Rd Ste D, Flint, MI 48532-5474 | 2017-05-25 |
| 1891232526 | Maureen Patricia Heathman | Registered Nurse | 470 E Summit St, Milford, MI 48381-1668 | 2017-01-19 |
| 1164897880 | Janet Sims | Registered Nurse | 8291 Frederick St, Salem, MI 48175 | 2015-12-07 |
| 1881085017 | Gina Cummings | Registered Nurse | 103 W Us2, Wakefield, MI 49968 | 2015-02-10 |
| 1376932772 | Sussie Chenault X | Registered Nurse | 25941 Twin Oak Drive, Taylor, MI 48180 | 2015-01-22 |
| Find all providers with the same taxonomy | ||||
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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.