| Doctor Name: | MS. CARMEN B. JACKSON |
| NPI Number: | 1205844347 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 332370 |
| Business Practice Address: | 1530 Route 9 Wappingers Falls, NY - 125904131 |
| Business Phone Number: | 8452972511 |
| Business Fax Number: | |
| Mailing Address: | 15 Regent Dr, HOPEWELL JUNCTION |
| State: | NY |
| Postal Code: | 125335503 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA2000X |
| License Number: | 332370 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Administrator |
| Taxonomy Definition: | |