Most Relevant Information
Provider Data
| NPI Number: | 1003356072 |
| Provider Name: | LISA JAECKLE |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 204983 |
Most Important Dates
| Enumeration Date: | 02/24/2017 |
| Last Updated: | 02/24/2017 |
Provider Practice Location
220 FLUVANNA AVE
JAMESTOWN
NY
147012052
Practice Location Phone/Fax
| Phone: | 7164871131 |
| Fax: |
Provider Mailing Location
220 FLUVANNA AVE
JAMESTOWN
NY
147012052
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |