Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NP10026 | CO |
NPI | 1154557056 |
---|---|
Provider Name | Jody Adele Jacobson |
First Address | Louisville, CO 80027-3258 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |