Individual
CLARK JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 S 60TH ST APT 21, LINCOLN, NE 68506-3579
(402) 613-2633
Mailing address
2500 S 60TH ST APT 21, LINCOLN, NE 68506-3579
(402) 613-2633
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
70693
NE
Other
Enumeration date
05/20/2016
Last updated
05/20/2016
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