Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO2893 | ME |
Y | 208000000X | Pediatrician | DO2893 | ME |
NPI | 1487016465 |
---|---|
Provider Name | Emily Alyson Jacobs |
First Address | Farmington, ME 04938-6144 |
Second Address | Portland, ME 04102-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 05/10/2019 |