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General NPI Number Information
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NPI Number | 1558529453
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Entity Type | Individual
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Provider Name | LISA JACOBSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 407 ULUNIU ST #411
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City | KAILUA
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State | HI
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Zip | 96734-2519
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Country | US
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Telephone | 808-263-7203
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Fax |
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Provider Business Mailing Address
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Address Line | 126 WAIHILI PL
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City | HONOLULU
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State | HI
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Zip | 96825-3522
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Country | US
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Telephone | 414-699-3956
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD-18387
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License Number State | HI
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