Individual
MS. JERI PAIRISH-LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
124 NW MIDLAND AVE, STE J, GRANTS PASS, OR 97526-1269
(541) 476-8859
(541) 955-8611
Mailing address
124 NW MIDLAND AVE, STE J, GRANTS PASS, OR 97526-1269
(541) 476-8859
(541) 955-8611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
OR
363LF0000X
Family Nurse Practitioner
Primary
094006084N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000473
—
OR
Enumeration date
07/21/2005
Last updated
10/01/2007
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