Healthcare Provider Details

I. General information

NPI: 1477362762
Provider Name (Legal Business Name): JACOB ANDREW DOWNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

52176 CENTRAL AVE
SOUTH BEND IN
46637-3808
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-3215
  • Fax:
Mailing address:
  • Phone: 574-261-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28220201A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: