Individual
SHANNON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2 LEHNER RD, SACO, ME 04072-1836
(207) 300-2471
Mailing address
2 LEHNER RD, SACO, ME 04072-1836
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN12738
ME
Other
Enumeration date
02/16/2023
Last updated
02/16/2023
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