Provider Demographics
NPI:1093713992
Name:JACOBSON, CORI L (CNM)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:L
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-8541
Mailing Address - Fax:419-480-1340
Practice Address - Street 1:PRESTON PLACE I 5180 CHAPPEL DRIVE
Practice Address - Street 2:BUILDING B
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7288
Practice Address - Country:US
Practice Address - Phone:567-585-0265
Practice Address - Fax:419-873-6188
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06073176B00000X
OHNM-06073367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA344428256OtherBEECH STREET
000000201559OtherANTHEM
OH2223534Medicaid
05225OtherPARAMOUNT
344428256072OtherCARESOURCE
OH344428256OtherHEALTH NET
MI4285606Medicaid
OH344428256OtherHEALTH NET
344428256072OtherCARESOURCE
OH2223534Medicaid