Individual provider · Type 1 NPI

Denise Lack, N.P.

Nurse Practitioner · Jackson, CA

NPI number 1104839414 Active

Practice location

100 Mission Blvd, Suite 2600
Jackson, CA 95642-2536

Fax (209) 257-1726

Mailing address

10470 Old Placerville Rd, Suite 100
Sacramento, CA 95827-2539

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000XRN392072 (CA)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1104839414

Denise Lack, N.P.'s National Provider Identifier is 1104839414, issued on Aug 15, 2006. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Jackson, CA. The record was last updated on Jul 10, 2015.