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Search › Ohio › 363LF0000X

Dominique Jackson, NURSE PRACTITIONER

NPI 1174081822 · on the registry since 2019

Practice

Address
1791 Alum Creek Dr Ste 100
Columbus, OH 43207
Phone
(614) 526-5420
Fax
(614) 645-5517
Organisation at this address
Maryhaven
Maryhaven Inc.
Maryhaven Inc.
Inferred from a shared address, not stated in the registry.
Clinicians at this address
344

Additional practice sites

  • 1301 Atlantic Ave, Atlantic City, NJ
  • 1 N White Horse Pike, Hammonton, NJ
  • 1301 Atlantic Ave, Atlantic City, NJ

Registry record

Primary taxonomy
363LF0000X
363LF0000X
Also registered as
390200000X
Licence states on file
OH
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2019-08-06

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Ohio