Individual
LORI ELIZABETH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
10315 DAWSONS CREEK BLVD STE AB, FORT WAYNE, IN 46825-1912
(260) 436-7875
(260) 432-9812
Mailing address
PO BOX 843603, DALLAS, TX 75284-0001
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28169386A
IN
Other
Enumeration date
07/28/2020
Last updated
07/12/2023
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