Individual
ELIZABETH ANNE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 MEDICAL PKWY, CARSON CITY, NV 89703-4625
(775) 445-8502
(775) 888-4448
Mailing address
PO BOX 21609, CARSON CITY, NV 89721-1609
(775) 884-2455
(775) 884-0345
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
5089
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538230545
—
NV
Enumeration date
11/13/2006
Last updated
12/18/2018
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