Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2018030068 | MO |
NPI | 1003383324 |
---|---|
Provider Name | Ms. Jennifer Marie Jacobi |
First Address | Saint Louis, MO 63119-4204 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 03/11/2021 |