Individual
LISA A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1730 MINOR AVE, SEATTLE, WA 98101-1498
(206) 442-5216
Mailing address
PO BOX 34584, SEATTLE, WA 98124-1584
(509) 241-7349
(509) 241-7628
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
MD00027646
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8342040
—
WA
Enumeration date
03/29/2007
Last updated
09/30/2009
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