SHAWANA JACKSON (NPI# 1659730414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659730414 |
| Entity Type | Individual |
| Full Name | SHAWANA JACKSON |
| Practice Address |
13715 Cordary Ave Apt 246 Hawthorne CA 90250-7419 |
| Practice Telephone | 3106610441 |
| Mailing Telephone | 3106610441 |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CAADE 5365-R | CA | Behavioral Health & Social Service Providers |
| Street Address |
13715 CORDARY AVE APT 246 |
| City | HAWTHORNE |
| State | CA |
| Zip Code | 90250-7419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508479627 | Alexis Lemmon | Dental Hygienist | 13450 Hawthrone Blvd, Hawthorne, CA 90250 | 2020-08-28 |
| 1336620459 | Lan Ngoc Ton | Dentist | 13450 S. Hawthorne Blvd, Hawthorne, CA 90250 | 2018-08-27 |
| 1356829261 | Karneth Health Inc | Internal Medicine | 4512 W. Imperial Hwy, Ste B, Hawthorne, CA 90250 | 2018-08-02 |
| 1225524663 | Viridian Healthcare LLC | In Home Supportive Care | 13658 Hawthorne Blvd Ste 201, Hawthorne, CA 90250 | 2018-07-09 |
| 1235636044 | Sonia Medical Center Inc | Clinic/Center | 4512 W Imperial Hwy, Hawthorne, CA 90250 | 2018-04-09 |
| 1518484807 | Jessica Anne-marie Auzenne-harris | Nurse Practitioner | 12618 Hawthorne Blvd, Hawthorne, CA 90250 | 2017-08-28 |
| 1669993358 | Ololade Olamide Obafemi | Nurse Practitioner | 12954 Hawthorne Boulevard, Suite 104, Hawthorne Morningside Medical Clinic, Hawthorne, CA 90250 | 2017-07-03 |
| 1588194534 | Marissam Medical Inc. | Durable Medical Equipment & Medical Supplies | 13508 Inglewood Ave, Hawthorne, CA 90250 | 2017-06-13 |
| 1043751886 | Ogbonna Iwuamadi Olelewe | Nurse Practitioner | 11712 S. Hawthorne Blvd, Hawthorne, CA 90250 | 2017-03-13 |
| 1952758898 | La Shada Kai Martin | Contractor | 13010 Kornblum Ave, Unit D, Hawthorne, CA 90250 | 2016-05-20 |
| Find all providers in zip 90250 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992212088 | Christine Marie Danielson | Counselor | 2501 W El Segundo Blvd Ste A, Hawthorne, CA 90250-3317 | 2018-01-10 |
| 1902262199 | Prudencesa P Renfro | Counselor | 4513 W 115th St Apt 10, Hawthorne, CA 90250 | 2016-01-04 |
| 1083966402 | Jerimiah Paxton Snyder | Counselor | 11973 Manor Drive, Hawthorne, CA 90250 | 2012-10-09 |
| 1881901320 | Vanessa Frazier | Counselor | 14037 Chadron Ave, Hawthorne, CA 90250-8234 | 2010-09-03 |
| 1689902546 | Edmond N Ekwegh | Counselor | 12713 Fonthill Ave, Hawthorne, CA 90250-4776 | 2009-12-03 |
| 1477887719 | John David Mcfarlin | Counselor | 107 Star Lake Dr, Hawthorne, FL 32640-6311 | 2009-09-18 |
| 1538388426 | Teddy Idehen | Counselor | 11633 Hawthorne Blvd Ste 210, Hawthorne, CA 90250-2322 | 2007-04-25 |
| 1801013990 | Chach Medical Aid | Counselor | 11633 Hawthorne Blvd Ste 215, Hawthorne, CA 90250-2322 | 2007-04-19 |
| 1417089871 | Obiageli Ifeoma Obah | Counselor | 13931 Chadron Ave Apt 20, Hawthorne, CA 90250-3150 | 2007-03-12 |
| 1821129883 | Peter Jerome Raymond | Counselor | 13951 Lemoli Ave, Hawthorne, CA 90250-8851 | 2007-03-08 |
| Find all providers in HAWTHORNE | ||||
Please comment or provide details below to improve the information on SHAWANA 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.