Individual
MICHELLE LAPORTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2880 MONROE AVE, LOVELAND, CO 80538-3274
(970) 613-6800
(970) 613-6801
Mailing address
2930 11TH AVE, EVANS, CO 80620-1011
(970) 350-4606
(970) 350-4645
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0007793
CO
Other
Enumeration date
08/17/2015
Last updated
02/09/2024
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