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General NPI Number Information
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NPI Number | 1548729445
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Entity Type | Individual
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Provider Name | EMILIE SUE JACOBSEN MD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 400 13TH AVE S STE 206
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City | GREAT FALLS
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State | MT
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Zip | 59405-4300
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Country | US
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Telephone | 406-731-8888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6010
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City | GREAT FALLS
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State | MT
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Zip | 59406-6010
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Country | US
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Telephone |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 140163
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 01090118A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 140163
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License Number State | MT
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