Individual
STACEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 S BROADWAY, SUITE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Mailing address
1015 S BROADWAY, SUITE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R38052
ND
Other
Enumeration date
01/04/2017
Last updated
01/04/2017
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