Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN190931 NP3893 | OH |
NPI | 1215924956 |
---|---|
Provider Name | Sandra Jacobs |
First Address | Columbus, OH 43205-2696 |
Second Address | Columbus, OH 43205-2696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2246500 | (05) | OH |
7102084000 | (05) | WV |
78012903 | (05) | KY |
P43730 | (02) |