Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 2369 | NE |
NPI | 1578959847 |
---|---|
Provider Name | Jessica P Jacobson |
First Address | Lincoln, NE 68506-1500 |
Second Address | Lincoln, NE 68506-1500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2017014908 | OTOLARYNGOLOGY, COSMETIC SURGERY (01) | MO |
2369 | OTOLARYNGOLOGY, COSMETIC SURGERY (01) | NE |