=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093713992
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORI L JACOBSON CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2005
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PRESTON PLACE I 5180 CHAPPEL DRIVE BUILDING B
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-7288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-585-0265
-----------------------------------------------------
Fax | 419-873-6188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2142 N COVE BLVD
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43606-3895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-291-8541
-----------------------------------------------------
Fax | 419-480-1340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 06073
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | NM-06073
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------