MS. SHANNA SHANEEN JACKSON (NPI# 1710506472) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710506472 |
| Entity Type | Individual |
| Full Name | MS. SHANNA SHANEEN JACKSON |
| Credential | NP |
| Practice Address |
12815 Heacock St Moreno Valley CA 92553-2836 |
| Mailing Address |
25315 Moorland Rd Moreno Valley CA 92551-9277 |
| Practice Telephone | 9516016149 |
| Practice Fax Number | 9516016036 |
| Mailing Telephone | 3234224640 |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-04-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 755399 | CA | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
95013739 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922492594 | Shanna Jackson | Counselor | 38271 Mound Rd Bldg B, Sterling Heights, MI 48310-3401 | 2015-03-23 |
| 1154845055 | Shanna Marie Jackson | Chiropractor | 105 E Main St, Bullard, TX 75757-5345 | 2017-08-01 |
| 1710197769 | Shanna Jackson | Technician, Other | 474 W 200 N, Suite 100, St George, UT 84770-4505 | 2007-05-22 |
| 1265657910 | Shanna Dawn Jackson | Counselor | 1900 Century Pl Ne, Ste 200, Atlanta, GA 30345-4307 | 2007-04-16 |
| Street Address |
12815 HEACOCK ST |
| City | MORENO VALLEY |
| State | CA |
| Zip Code | 92553-2836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871566778 | Benito B Perez Jr. | Family Medicine | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2006-02-10 |
| 1861054645 | Alma Y. Baeza | Marriage & Family Therapist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2019-07-02 |
| 1649838699 | Andrea Marie Noyes Bruhn | Marriage & Family Therapist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2019-06-04 |
| 1841761061 | Eshban Kyunghyun Lee | Pharmacist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2018-12-16 |
| 1669943023 | Nicolas Kyung Joon Min | Pharmacist | 12815 Heacock St, Moreno Valley, CA 92553-2836 | 2018-12-11 |
| 1285124172 | Matthew David Gilford | Marriage & Family Therapist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2018-05-16 |
| 1831560952 | Stanley Poon | Pharmacist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2015-10-15 |
| 1154709657 | Han-lin Sung | Family Medicine | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2015-05-15 |
| 1194113977 | Jana Pitts | Marriage & Family Therapist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2015-01-02 |
| 1851705842 | Martin Anh Duc Bui | Pharmacist | 12815 Heacock St, Moreno Valley, CA 92553-3116 | 2014-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104441559 | Tanya Gentle | Marriage & Family Therapist | 2319 Cottonwood Avenue, Building A Suite 110, Moreno Valley, CA 92553 | 2020-06-11 |
| 1275194227 | Antonio Pearce | Psychologist | 12968 Frederick Street, Suite D, Moreno Valley, CA 92553 | 2019-06-20 |
| 1346726486 | Elias Y. Rached | Chiropractor | 23846 Sunnymead Blvd Ste 4, Moreno Valley, CA 92553 | 2018-07-12 |
| 1952813420 | Shanaya Frederick | Driver | 14929 Spinnaker Lane, Moreno Valley, CA 92553 | 2017-10-24 |
| 1457879413 | R & C Logistic Services, LLC | Private Vehicle | 14768 Briana St, Moreno Valley, CA 92553 | 2017-08-30 |
| 1720505084 | Elda Pricila Hernandez | Behavioral Analyst | 24596 Atwood Ave.apt1, Moreno Valley, CA 92553 | 2017-08-28 |
| 1174044101 | Ps Medical Supplies Inc | Durable Medical Equipment & Medical Supplies | 24594 Sunnymead Blvd, Suite M, Moreno Valley, CA 92553 | 2017-06-29 |
| 1942736327 | Richard Pantoja Reyna | Licensed Vocational Nurse | 23119 Cottonwood Ave Bld A Suite 110, Moreno Valley, CA 92553 | 2017-05-04 |
| 1255872719 | Sibonisiwe Moyo Johnson | Nurse Practitioner | 22555 Alessandro Blvd Ste B, Moreno Valley, CA 92553 | 2017-03-16 |
| 1518311190 | Ryan Macavinta | Nurse Practitioner | 22765 Alessandro Blvd., Moreno Valley, CA 92553 | 2016-04-20 |
| Find all providers in zip 92553 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851999718 | La Creasure White | Nurse Practitioner | 10271 Prospector Ln, Moreno Valley, CA 92557-4238 | 2020-10-13 |
| 1255945200 | Michael Jay Rendle | Nurse Practitioner | 12032 Champlain St, Moreno Valley, CA 92557-7713 | 2020-09-06 |
| 1013553064 | Natasha Mirella Ramirez | Nurse Practitioner | 22575 Cobble Creek Dr, Moreno Valley, CA 92557-2617 | 2019-11-25 |
| 1730721861 | Roseline Igho Enobakhare | Nurse Practitioner | 13431 Nottingham Ave, Moreno Valley, CA 92555-8413 | 2019-10-10 |
| 1225690449 | Jeremiah Umeh | Nurse Practitioner | 13072 Day St # A301, Moreno Valley, CA 92553-7334 | 2019-07-09 |
| 1679044093 | Reni Zachariah | Nurse Practitioner | 24318 Hemlock Ave Ste E1, Moreno Valley, CA 92557-7225 | 2018-12-11 |
| 1336647742 | Sherle Glenn Rubin | Nurse Practitioner | 13845 Roderick Dr, Moreno Valley, CA 92555-6117 | 2018-01-31 |
| 1689186975 | Linda Yvette Perez | Nurse Practitioner | 22635 Alessandro Blvd Ste A, Moreno Valley, CA 92553-8550 | 2017-10-26 |
| 1063938603 | Anthony I Odimegwu | Nurse Practitioner | 26062 Bercaw Ct, Moreno Valley, CA 92555 | 2017-08-16 |
| 1386195212 | Myla Lara Natividad | Nurse Practitioner | 26323 Old Anvil Ln, Moreno Valley, CA 92555-2935 | 2016-10-14 |
| Find all providers in MORENO VALLEY | ||||
| City | MORENO VALLEY |
| Zip Code | 92553 |
Please comment or provide details below to improve the information on MS. SHANNA SHANEEN 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.