Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003115965 |
---|---|
Provider Name | Jennifer Jacobsen |
First Address | Carson City, NV 89701-3113 |
Second Address | Carson City, NV 89701-3113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2011 |
Last Update Date | 17/03/2011 |