Individual
LORI K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-0111
(207) 795-2766
Mailing address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-0111
(207) 795-2766
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA852
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912965880
—
ME
Enumeration date
05/02/2006
Last updated
06/03/2016
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