Individual
LUKE JARVIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1400 29TH ST S, GREAT FALLS, MT 59405-5353
(409) 454-2171
Mailing address
543 W 2700 N, NEPHI, UT 84648-3004
(435) 531-9643
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
NUR-RN-LIC-74240
MT
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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