Provider Demographics
NPI:1245115849
Name:JACKSON, JONEETHA CHRISTEL
Entity type:Individual
Prefix:
First Name:JONEETHA
Middle Name:CHRISTEL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 WELLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3195
Mailing Address - Country:US
Mailing Address - Phone:313-808-6833
Mailing Address - Fax:
Practice Address - Street 1:3901 WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3195
Practice Address - Country:US
Practice Address - Phone:313-808-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty