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General NPI Number Information
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NPI Number | 1164219242
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Entity Type | Individual
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Provider Name | LENA JACOBSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5153
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Country | US
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Telephone | 505-265-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 916 MESA ROJA TRL NE
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City | RIO RANCHO
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State | NM
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Zip | 87124-6389
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Country | US
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Telephone | 505-514-1665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 83731
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 83731
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License Number State | NM
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