Individual
LORI LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDCES
Contact information
Practice address
1315 E 24TH ST STE 1, MINNEAPOLIS, MN 55404-3959
(612) 721-9872
(612) 721-2904
Mailing address
1315 E 24TH ST STE 1, MINNEAPOLIS, MN 55404-3959
(612) 721-9872
(612) 721-2904
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
2459891
MN
Other
Enumeration date
07/09/2021
Last updated
07/09/2021
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