Individual provider · Type 1 NPI

Shante Octavia Jackson, LPN

Licensed Practical Nurse · Phila, PA

NPI number 1982594313 Active

Practice location

50 E Willow Grove Ave Apt 1
Phila, PA 19118-3464

Call (856) 514-0073 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000XLPN303611 (PA)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1982594313

Shante Octavia Jackson, LPN's National Provider Identifier is 1982594313, issued on Jul 7, 2025. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Phila, PA. The record was last updated on Jul 23, 2026.