Individual
MISS ELAINE MAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
426 1ST AVE, TWO HARBORS, MN 55616-1614
(218) 343-2308
(218) 834-2918
Mailing address
426 1ST AVE, TWO HARBORS, MN 55616-1614
(218) 834-0712
(218) 834-2918
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Enumeration date
02/01/2016
Last updated
02/01/2016
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