Jackson, Lisa

Jackson, Lisa is an individual health care provider with primary practice located at 2619 Product Dr , Rochester Hills MI 48309-3807. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Jackson, Lisa can be contacted via phone (248) 844-9650.

Contact Information

Primary practice address
2619 Product Dr Rochester Hills MI 48309-3807
Phone: (248) 844-9650
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X 4703090363 Michigan

Profile Details

NPI number 1154655488
LBN Legal business name Jackson, Lisa
Credentials Licensed Practical Nurse (LPN)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 18th, 2009
Last updated Sep 18th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154655488 NPPES
Michigan MEDICAID 3062098

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