Healthcare Provider Details

I. General information

NPI: 1164943783
Provider Name (Legal Business Name): EMILY JACOBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20046 RONSDALE DR
BEVERLY HILLS MI
48025-3856
US

IV. Provider business mailing address

20046 RONSDALE DR
BEVERLY HILLS MI
48025-3856
US

V. Phone/Fax

Practice location:
  • Phone: 734-604-6014
  • Fax:
Mailing address:
  • Phone: 734-604-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH1100X
TaxonomyHolistic Clinical Nurse Specialist
License Number4704230294
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: