Individual
MELISSA LOUSIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4 VICTORY LN, SCARBOROUGH, ME 04074-8486
(207) 939-7627
Mailing address
4 VICTORY LN, SCARBOROUGH, ME 04074-8486
(207) 939-7627
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
MT3643
ME
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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