Healthcare Provider Details

I. General information

NPI: 1093280828
Provider Name (Legal Business Name): WEB NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 W 2ND AVE STE 100
SPOKANE WA
99201-4540
US

IV. Provider business mailing address

651 MALL DR UNIT 59294
SCHAUMBURG IL
60159-3216
US

V. Phone/Fax

Practice location:
  • Phone: 224-456-7660
  • Fax:
Mailing address:
  • Phone: 224-456-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JACOBS
Title or Position: OWNER
Credential: NP
Phone: 224-456-7660