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General NPI Number Information
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NPI Number | 1376479626
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Entity Type | Individual
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Provider Name | LUKE S JACKSON CRITICAL CARE RN
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Gender | Male
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 300 MAIN ST
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City | LEWISTON
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State | ME
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Zip | 04240-7027
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Country | US
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Telephone | 207-275-2961
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Fax |
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Provider Business Mailing Address
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Address Line | 189 ODLIN RD
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City | BANGOR
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State | ME
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Zip | 04401-6703
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Country | US
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Telephone | 207-275-2961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 30299
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 163WF0300X
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Taxonomy Name | Flight Registered Nurse
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License Number | RN79258
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License Number State | ME
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