Healthcare Provider Details

I. General information

NPI: 1326317686
Provider Name (Legal Business Name): MONICA KOCH JAKUBOWSKI NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 DUKE HOSPITAL N BOX 100500
DURHAM NC
27710-0001
US

IV. Provider business mailing address

5524 DUKE HOSPITAL N BOX 100500
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-5551
  • Fax: 919-681-7770
Mailing address:
  • Phone: 919-681-5551
  • Fax: 919-681-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number930169
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: