| Doctor Name: | MISS ELAINE MAE JACKSON |
| NPI Number: | 1548628860 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 426 1st Ave Two Harbors, MN - 556161614 |
| Business Phone Number: | 2183432308 |
| Business Fax Number: | 2188342918 |
| Mailing Address: | 426 1st Ave, TWO HARBORS |
| State: | MN |
| Postal Code: | 556161614 |
| Phone Number: | 2188340712 |
| Fax Number: | 2188342918 |
| NPI Enumeration Date: | 02/01/2016 |
| NPI Last Update Date: | 02/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |