MEDICARE: KASHARA ANNE JACOBS 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
1	163W00000X	Registered Nurse	425708	OH

General Provider Information

NPI Number	:	1821446105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASHARA ANNE JACOBS RN

Provider Business Mailing Address
First Line	:	2383 NOBLE RD APT4
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121
Country	:	US
Telephone Number	:	216-501-2043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2383 NOBLE RD APT 4
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1448
Country	:	US
Telephone Number	:	216-501-2043
Fax Number	:

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

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	05/27/2016

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