Provider Demographics
NPI:1952295974
Name:JACKSON, BROOKE RENEE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:RENEE
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 1:1700 BLANKENSHIP RD APT I4
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4137
Mailing Address - Country:US
Mailing Address - Phone:971-291-2668
Mailing Address - Fax:
Practice Address - Street 1:1700 BLANKENSHIP RD APT I4
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4137
Practice Address - Country:US
Practice Address - Phone:971-291-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula