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1518570589
LESA MARIE JACKSON
IRMO, SC
NPI
1518570589
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: SC 23640)
Enumeration Date
2020-08-28
Last Update Date
2020-08-28
Business Address
LESA MARIE JACKSON APRN
14 RAINTREE CT
IRMO, SC 29063-9431
Phone number: 417-459-3020
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Mailing Address
LESA MARIE JACKSON APRN
14 RAINTREE CT
IRMO, SC 29063-9431
Phone number: 417-459-3020
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