Individual
LISA ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2010 OLD W CHESTER PIKE, SUITE 330, HAVERTOWN, PA 19083-2712
(610) 789-8070
(610) 789-9937
Mailing address
PO BOX 650782, DALLAS, TX 75265
(610) 789-8070
(610) 789-9937
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
081637
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081637
AANA
PA
01
—
RN328670L
RN LICENSE
PA
Enumeration date
01/16/2009
Last updated
01/16/2009
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