Healthcare Provider Details

I. General information

NPI: 1467519504
Provider Name (Legal Business Name): CARRIE H JACOBSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 6D INMEP SAN FRANCISCO GENERA
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

253 THERESA ST
SAN FRANCISCO CA
94112-1933
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5106
  • Fax:
Mailing address:
  • Phone: 415-334-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: