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General NPI Number Information
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NPI Number | 1194864033
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Entity Type | Individual
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Provider Name | MARILYN J. JACOBS RNC, WHNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2817 MC CLELLAND BLVD SUITE 56
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City | JOPLIN
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State | MO
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Zip | 64804-1629
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Country | US
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Telephone | 417-206-7474
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Fax | 417-624-5923
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Provider Business Mailing Address
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Address Line | 2817 MC CLELLAND BLVD SUITE 56
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City | JOPLIN
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State | MO
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Zip | 64804-1629
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Country | US
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Telephone | 417-206-7474
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Fax | 417-624-5923
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 035525
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License Number State | MO
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