Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 11552 | CA |
NPI | 1093240491 |
---|---|
Provider Name | Mrs. Tami Janine Jacobson |
First Address | Upland, CA 91786-3164 |
Second Address | Upland, CA 91786-3164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 24/04/2017 |