Provider Demographics
NPI:1073380937
Name:JACOBSON, DAWN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 E BEVERS ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9430
Mailing Address - Country:US
Mailing Address - Phone:719-680-9047
Mailing Address - Fax:
Practice Address - Street 1:4066 E MONSANTO DR UNIT E
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-8512
Practice Address - Country:US
Practice Address - Phone:520-335-6118
Practice Address - Fax:888-504-1425
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN196043163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice