Provider Demographics
NPI:1235910233
Name:JACOBS, SHILETTER (CD)
Entity Type:Individual
Prefix:
First Name:SHILETTER
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3128
Mailing Address - Country:US
Mailing Address - Phone:910-431-8525
Mailing Address - Fax:
Practice Address - Street 1:502 CLAY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3128
Practice Address - Country:US
Practice Address - Phone:910-431-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula