Provider Demographics
NPI:1356007124
Name:KREBS, JACOB ALAN (RN)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ALAN
Last Name:KREBS
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 1:3679 173RD LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-1039
Mailing Address - Country:US
Mailing Address - Phone:763-238-2499
Mailing Address - Fax:
Practice Address - Street 1:3679 173RD LN NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-1039
Practice Address - Country:US
Practice Address - Phone:763-238-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2487478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse