Individual
LISA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1520 E CALHOUN ST, ANDERSON, SC 29621-2210
(864) 260-5090
Mailing address
1520 E CALHOUN ST, ANDERSON, SC 29621-2210
(864) 260-5090
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
44018
SC
Other
Enumeration date
12/09/2016
Last updated
12/09/2016
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