Lisa Jack

NPI #1053041830 in Wichita, Kansas

Provider Information

NPI Number: 1053041830
Entity Type: Individual
Name: Lisa Jack
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Jun 14, 2022
Last Updated: Jun 14, 2022

Practice Location

Address: 8625 E 37TH ST N STE 101
City: Wichita
State: Kansas
ZIP Code: 67226-2008
Phone: (316) 648-8545

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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