MEDICARE: MS. STEPHANIE L JACOBS

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
1	163W00000X	Registered Nurse	RN962408	MD
2	163WM0705X	Medical-Surgical Registered Nurse	RN962408	MD

General Provider Information

NPI Number	:	1740791086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE L JACOBS

Provider Business Mailing Address
First Line	:	4911 7TH PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2328
Country	:	US
Telephone Number	:	240-552-6551
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 7TH PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2328
Country	:	US
Telephone Number	:	240-552-6551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	10/13/2017

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