Search › Louisiana › 171M00000X
Lisa Jack
NPI 1942739404 · on the registry since 2017 · sole proprietor
Practice
- Address
- 613 East St
Mamou, LA 70554 - Phone
- (337) 655-1132
Registry record
- Primary taxonomy
- 171M00000X
171M00000X
- Also registered as
- 101YM0800X
- Licence states on file
- NULL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2018-06-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Louisiana