| Ms Shanna Shaneen Jackson, NP | |
|
24060 Fir Ave Ste A, Moreno Valley, CA 92553-2895 | |
| (951) 247-8005 | |
| Not Available |
| Full Name | Ms Shanna Shaneen Jackson |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Experience | 3 Years |
| Location | 24060 Fir Ave Ste A, Moreno Valley, California |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710506472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 163W00000X | Registered Nurse | 755399 (California) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 95013739 (California) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Southern California Permanente Medical Group | 6002729175 | 7951 |
| Entity Name | Southern California Permanente Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316979834 PECOS PAC ID: 6002729175 Enrollment ID: O20040126000823 |
| Entity Name | Go Gently Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1447889274 PECOS PAC ID: 9931510187 Enrollment ID: O20210331001579 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Shanna Shaneen Jackson, NP 25315 Moorland Rd, Moreno Valley, CA 92551-9277 Ph: (323) 422-4640 | Ms Shanna Shaneen Jackson, NP 24060 Fir Ave Ste A, Moreno Valley, CA 92553-2895 Ph: (951) 247-8005 |
Lajean Avon Forbes, CNM Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 12712 Heacock St, Suite 7, Moreno Valley, CA 92553 Phone: 951-924-6824 Fax: 951-601-9302 | |
Susan Launa Weeks, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 26520 Cactus Ave, Moreno Valley, CA 92555 Phone: 951-486-5162 Fax: 818-843-5224 | |
Mfon-obong Nseuwa Etukudoh, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 12900 Frederick St Ste C, Moreno Valley, CA 92553 Phone: 888-743-7526 | |
Magen Ashley Costilla, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 26600 Cactus Ave Ste 300, Moreno Valley, CA 92555 Phone: 951-988-9500 | |
Holly Vanderhyde, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 12364 Perris Blvd, Moreno Valley, CA 92557 Phone: 605-209-6421 | |
Mrs. Vanessa Renee Smith Constantino, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 25970 Iris Ave Ste 3b, Moreno Valley, CA 92551 Phone: 951-924-2775 | |
Lloydette H Brewah, DNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 14934 Tarragon Way, Moreno Valley, CA 92553 Phone: 951-269-0542 |