DENISE LACK (NPI# 1104839414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104839414 |
| Entity Type | Individual |
| Full Name | DENISE LACK |
| Credential | N.P. |
| Practice Address |
100 Mission Blvd Suite 2600 Jackson CA 95642-2536 |
| Mailing Address |
10470 Old Placerville Rd Suite 100 Sacramento CA 95827-2539 |
| Practice Telephone | 2092571722 |
| Practice Fax Number | 2092571726 |
| Mailing Telephone | 8557710335 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2015-07-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | RN392072 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
100 MISSION BLVD SUITE 2600 |
| City | JACKSON |
| State | CA |
| Zip Code | 95642-2536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790777662 | Robert Ellsworth Young II | Obstetrics & Gynecology | 100 Mission Blvd, Suite 2800, Jackson, CA 95642-2536 | 2005-08-17 |
| 1508209909 | Surgical Affiliates of California, Inc. | Clinic/Center | 100 Mission Blvd, Suite B116, Jackson, CA 95642-2536 | 2013-04-16 |
| 1164794012 | Sutter Valley Hospitals | Clinical Medical Laboratory | 100 Mission Blvd, Jackson, CA 95642-2536 | 2012-02-07 |
| 1033499215 | April Michelle Boitano | Advanced Practice Midwife | 100 Mission Blvd, Suite 2800, Jackson, CA 95642-2536 | 2011-08-19 |
| 1497058473 | Maureen Patricia Mooney-michels | Dietitian, Registered | 100 Mission Blvd, Outpatient Diabetes Education Program, Jackson, CA 95642-2536 | 2010-12-13 |
| 1295053833 | Aye Myat Moe | Pediatrics | 100 Mission Blvd, Suite 2600, Jackson, CA 95642-2536 | 2010-05-06 |
| 1861644635 | Melanie M Trowbridge | Psychologist | 100 Mission Blvd, Suite 2800, Jackson, CA 95642-2536 | 2008-10-10 |
| 1760657720 | Yosemite Pathology Medical Group, Inc | Clinical Medical Laboratory | 100 Mission Blvd, Jackson, CA 95642-2536 | 2008-04-29 |
| 1679742951 | Rachel F Clay | Obstetrics & Gynecology | 100 Mission Blvd, Suite 2800, Jackson, CA 95642-2536 | 2008-02-21 |
| 1134293459 | Amy A. Appleton | Pediatrics | 100 Mission Blvd, Suite 2600, Jackson, CA 95642 | 2006-11-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932666575 | Gold Country Health Initiative, LLC | Family Medicine | 820/830 State Highway 88, Jackson, CA 95642 | 2019-03-01 |
| 1053844902 | Kathryn Erosa | Pharmacist | 515 Highway 49 South, Jackson, CA 95642 | 2017-04-07 |
| 1356882039 | Thomas Alan Bowhay | Clinic/Center | 820 Highway 88, Jackson, CA 95642 | 2017-03-15 |
| 1710130141 | Roland E Womack | Dentist | 511 Sutter St, Jackson, CA 95642 | 2008-10-29 |
| 1508929522 | Stanley M Ordonez | Dentist | 645 New York Ranch Rd, Jackson, CA 95642 | 2006-12-19 |
| 1942374996 | Thomas W Zeiler | Chiropractor | 665 New York Ranch Rd Suite 2, Jackson, CA 95642 | 2006-11-20 |
| 1023188968 | Cordelia Rose Slayter | Physical Therapist | 711 S State Hwy 49, Jackson, CA 95642 | 2006-11-08 |
| 1285744946 | Raleys | Pharmacy | 781 South Highway 49, Jackson, CA 95642 | 2006-08-30 |
| 1316996747 | Robert R. Bussell X | Physical Therapist | 813 Court Street, Ste 2, Jackon, CA 95642 | 2006-05-10 |
| 1861953135 | Chelsea Yule Solutions | Clinic/Center | 230 N Main St, Jackson, CA 95642 | 2019-03-28 |
| Find all providers in zip 95642 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | 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 with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093332546 | Jaleesa Atkins | Nurse Practitioner | 4266 Springbrook Rd, Jackson, MI 49201-9716 | 2020-07-01 |
| 1457983785 | Amos N Macharia | Nurse Practitioner | 2130 Ridge Rd, Jackson, MO 63755-1612 | 2020-02-05 |
| 1649819590 | George Cavett Jr. | Nurse Practitioner | 2450 Twisted Oak Dr, Jackson, MS 39212-2137 | 2019-12-24 |
| 1851934723 | Hannah Louise Keel | Nurse Practitioner | 623 Gettysburg Dr, Jackson, TN 38305-7886 | 2019-10-23 |
| 1013559186 | Kirsten Siler | Nurse Practitioner | 27a Medical Center Drive, Jackson, TN 38301-3949 | 2019-10-10 |
| 1801447693 | Milestone Primary Care House Calls, LLC | Nurse Practitioner | 5260 Cedar Park Dr Ste E, Jackson, MS 39206-4131 | 2019-09-24 |
| 1750855870 | Michael L Chesney | Nurse Practitioner | 6055 Jordan Rd, Jackson, MI 49201-9580 | 2019-01-12 |
| 1609356500 | Angela Sophia Mcreynolds | Nurse Practitioner | 2500 N State St Rm S347, Jackson, MS 39216-4500 | 2018-08-20 |
| 1679050132 | Alicia Faye Green | Nurse Practitioner | 908 Bella Vista Dr, Jackson, MO 63755-7863 | 2018-07-26 |
| 1982119228 | Felix Taylor | Nurse Practitioner | 514 E Woodrow Wilson Ave Ste B, Jackson, MS 39216-4538 | 2017-12-08 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on DENISE LACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.