| NPI | 1871841338 |
|---|---|
| Former Name | LISA ANN JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36000648A) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |