Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 20482 | CA |
NPI | 1043515414 |
---|---|
Provider Name | Mrs. Abby Jean Jacobs |
First Address | Fresno, CA 93721-1324 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2011 |
Last Update Date | 03/12/2019 |