Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP30004784 | WA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN00074045 | WA |
NPI | 1033118344 |
---|---|
Provider Name | Erin Alane Jacobson |
First Address | Lakewood, WA 98499-8368 |
Second Address | Lakewood, WA 98499-8368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 02/06/2017 |