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Individual
MS. LISA CHANEL JACKSON
Active
Individual
MS. LISA CHANEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036113699
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
33355
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113699
—
IL
05
—
33352
—
SC
Enumeration date
07/14/2006
Last updated
06/13/2026
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