Lisa Waite Jacobson
Facial Plastic Surgeon
8872 Professional Dr
Cadillac
, Michigan 49601-8481
Lisa Waite Jacobson
Facial Plastic Surgeon
8872 Professional Dr
Cadillac
, Michigan 49601-8481
(231) 779-6264
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About
Features
Specialties
- Facial Plastic Surgeon
Languages spoken
- English
Location
First Address
- Lisa Waite Jacobson
- 8872 Professional Dr
- Cadillac, MI
- Zip : 49601-8481
- Fax : (231) 779-6264
- Phone : (231) 779-6260
Second Address
- Lisa Waite Jacobson
- 8872 Professional Dr
- Cadillac, MI
- Zip : 49601-8481
- Fax : (231) 779-6264
- Phone : (231) 779-6260
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YS0123X | Facial Plastic Surgeon | 5101013549 | MI |
National Provider Identifier
| NPI | 1922073766 |
|---|---|
| Provider Name | Lisa Waite Jacobson |
| First Address | Cadillac, MI 49601-8481 |
| Second Address | Cadillac, MI 49601-8481 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/02/2006 |
| Last Update Date | 24/10/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 4420424 | (05) | MI |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.