Provider Demographics
NPI:1386046605
Name:JACOBS, JAMMIE LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:JAMMIE
Middle Name:LYNN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-4301
Mailing Address - Country:US
Mailing Address - Phone:651-734-8700
Mailing Address - Fax:
Practice Address - Street 1:668 WILLOW ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-4301
Practice Address - Country:US
Practice Address - Phone:651-734-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN317695164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse