Provider Demographics
NPI:1285330951
Name:JACOBS, EVE (CNM)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:GOERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2373 WINDSOR MEADOW BLVD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1394
Mailing Address - Country:US
Mailing Address - Phone:708-574-8392
Mailing Address - Fax:
Practice Address - Street 1:2373 WINDSOR MEADOW BLVD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63038-1394
Practice Address - Country:US
Practice Address - Phone:708-574-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022041566367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife