Individual
LISA M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
6307 DEBARR RD STE C, ANCHORAGE, AK 99504-1783
(907) 333-7425
(907) 333-7719
Mailing address
6307 DEBARR RD STE C, ANCHORAGE, AK 99504-1783
(907) 333-7425
(907) 333-7719
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
322
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730113739
GROUP NPI
AK
05
—
NP6817
—
AK
Enumeration date
08/13/2007
Last updated
10/18/2007
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