Individual provider · Type 1 NPI

Jackson Lawrence Lisotta, SRNA

Student in an Organized Health Care Education/Training Program · Winston Salem, NC

NPI number 1831043330 Active

Practice location

525 Vine St
Winston Salem, NC 27101-4125

Call (336) 716-1411 Map

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000X365263 (NC)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1831043330

Jackson Lawrence Lisotta, SRNA's National Provider Identifier is 1831043330, issued on Feb 23, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Winston Salem, NC. The record was last updated on Feb 23, 2026.