IndividualActive
Edna Jackson, RN
NPI 1114097870 · Administrator Registered Nurse · Detroit, MI
Provider details
- NPI number
- 1114097870
- Entity type
- Individual
- Primary specialty
- Administrator Registered NurseNursing Service Providers
- Credential
- RN
- Sex
- Female
- Sole proprietor
- No
- License
- 4704118498 (MI)
Specialties & taxonomies
Nursing Service Providers
Practice location
2395 W Grand Blvd
Detroit, MI 48208-1210
Phone: (313) 897-2061
Approximate (ZIP-level) locationGet directions
Mailing address
18001 Saint Marys St
Detroit, MI 48235-3176
Registry dates
- Enumerated
- 2006-11-09
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.