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NPI Code Detail

MEDICARE: MRS. LOUISE A. JACOBSON NCC

MEDICARE: MRS. LOUISE A. JACOBSON NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor27648ND

General Provider Information

NPI Number : 1164592747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LOUISE A. JACOBSON NCC
Provider Business Mailing Address
First Line : 4868 MARCO POLO ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-0267
Country : US
Telephone Number : 702-526-3455
Fax Number : 702-586-1114
Provider Business Practice Location Address
First Line : 4868 MARCO POLO ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-0267
Country : US
Telephone Number : 702-526-3455
Fax Number : 702-586-1114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/16/2009

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