Provider Demographics
NPI:1194864033
Name:JACOBS, MARILYN J (RNC, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:J
Last Name:JACOBS
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Gender:F
Credentials:RNC, WHNP
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Mailing Address - Street 1:2817 MC CLELLAND BLVD
Mailing Address - Street 2:SUITE 56
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1629
Mailing Address - Country:US
Mailing Address - Phone:417-206-7474
Mailing Address - Fax:417-624-5923
Practice Address - Street 1:2817 MC CLELLAND BLVD
Practice Address - Street 2:SUITE 56
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1629
Practice Address - Country:US
Practice Address - Phone:417-206-7474
Practice Address - Fax:417-624-5923
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO035525363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health