Individual
LAURICE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
40 WINTER ST, ROCHESTER, NH 03867-3153
(603) 332-5500
(603) 332-0410
Mailing address
652F CENTRAL AVE, DOVER, NH 03820-3414
(603) 749-2346
(603) 953-0066
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
010948-23-03
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000875
—
NH
Enumeration date
04/28/2006
Last updated
07/08/2007
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