Provider Demographics
NPI:1528421955
Name:JACKSON, MICHAEL JAMES (RNFA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:JACKSON
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4704
Mailing Address - Country:US
Mailing Address - Phone:207-318-4072
Mailing Address - Fax:
Practice Address - Street 1:19 CURTIS DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4704
Practice Address - Country:US
Practice Address - Phone:207-318-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-02
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER048931163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant