Provider Demographics
NPI:1164291464
Name:JACOBSON, SETH JOSEPH (RN)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:JOSEPH
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1626
Mailing Address - Country:US
Mailing Address - Phone:206-228-3327
Mailing Address - Fax:
Practice Address - Street 1:5102 20TH ST E STE 101
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98424-1996
Practice Address - Country:US
Practice Address - Phone:360-471-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60284414163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine