Individual
JACKSON EDGAR HAEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
552 N PINE ST, LARAMIE, WY 82072-2451
(720) 256-4685
Mailing address
552 N PINE ST, LARAMIE, WY 82072-2451
(720) 256-4685
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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