Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 930169 | NC |
NPI | 1326317686 |
---|---|
Provider Name | Mrs. Monica Koch Jakubowski |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 15/12/2011 |