Individual
LORI JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
934 MAIN ST, SAINT GEORGE ISLAND, AK 99591
(907) 859-2254
(907) 859-2252
Mailing address
17115 MONROE DR NW, ELK RIVER, MN 55330-4307
(612) 239-3393
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
130523
AK
Other
Enumeration date
04/12/2018
Last updated
06/16/2018
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