Individual
DIANA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-7575
(207) 795-7133
Mailing address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-7575
(207) 795-7133
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
CNP171007
ME
363LF0000X
Family Nurse Practitioner
Primary
CNP171007
ME
363LG0600X
Gerontology Nurse Practitioner
CNP171007
ME
Other
Enumeration date
03/15/2017
Last updated
03/24/2025
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