Provider Demographics
NPI:1306264643
Name:JACOBSON, DAWN MARIE (MD, MPH)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3045
Mailing Address - Country:US
Mailing Address - Phone:651-600-3035
Mailing Address - Fax:651-528-6149
Practice Address - Street 1:1687 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3045
Practice Address - Country:US
Practice Address - Phone:651-600-3035
Practice Address - Fax:651-528-6149
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2025-02-05
Deactivation Date:2025-01-31
Deactivation Code:
Reactivation Date:2025-02-04
Provider Licenses
StateLicense IDTaxonomies
WAMD613450492083P0500X
CAA674992083P0901X
MEMD245272083P0901X
NJ25MA116692002083P0901X
MN687072083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine