NPI 1053041830
Lisa Jack
Practice location
- Address
- 8625 E 37th St N STE 101, Wichita, KS 67226-2008
- Phone
- (316) 648-8545
- Mailing address
- 5709 E 17th St N, Wichita, KS 67208-1703
Registered specialties
Specialist
Primary
Registry record
- NPI
- 1053041830
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 14 Jun 2022
- Record last updated
- 14 Jun 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.