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NPI Code Detail

MEDICARE: JANE JACOBSON RN

MEDICARE:   JANE  JACOBSON  RN
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
1163W00000XRegistered Nurse393720-1NY

General Provider Information

NPI Number : 1578984373
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE JACOBSON RN
Provider Business Mailing Address
First Line : 7 WOODCLEFT AVE
Second Line :
City : PORT WASHINGTON
State : NY
Zip : 11050-2736
Country : US
Telephone Number : 516-883-1288
Fax Number :
Provider Business Practice Location Address
First Line : 7 WOODCLEFT AVE
Second Line :
City : PORT WASHINGTON
State : NY
Zip : 11050-2736
Country : US
Telephone Number : 516-883-1288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2013
Last Update Date : 12/20/2013

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