SHANNON JACKSON

MISHAWAKA, IN
NPI1134616584
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: IN  10005009A)
Additional Taxonomies363A00000X Physician Assistant
(Licence: MI  5601011128)
Enumeration Date2018-04-20
Last Update Date2025-10-14
Business Address
SHANNON JACKSON PA-C
611 E DOUGLAS RD STE 203
MISHAWAKA, IN 46545-1467
Phone number: 574-335-6640
Mailing Address
SHANNON JACKSON PA-C
5215 HOLY CROSS PKWY
MISHAWAKA, IN 46545-1469
Phone number: