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Jackson Luther

NPI Registration Record

Provider / OrganizationNPIDate Certified
JACKSON LUTHER11448974632021-06-06

Jackson Luther is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1144897463. Registration indicates Jackson Luther is a provider of services with a specialization in Technologists, Technicians & Other Technical Service Providers, Technician, Other (Technician, Other, ) (Technician, Other, Technologists, Technicians & Other Technical Service Providers)

Entity TypeIndividual
Provider Name Jackson Luther
Practice Office Address4140 RICHARD AVE STE 200
HERMANTOWN, MN US
Practice Office Telephone2185145230
Mailing Address731 E 7TH ST APT 2
DULUTH, MN 558053411 US
HPT Codes
CodePractice
License No
State
247200000X PRIMARY
Technologists, Technicians & Other Technical Service Providers
Technician, Other
Technician, Other

Technician, Other
Technologists, Technicians & Other Technical Service Providers
OPI Codes

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