Provider Demographics
NPI:1366623357
Name:JACOBS, JAMIE LYNNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNNE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9875 ROLLER RD
Mailing Address - Street 2:
Mailing Address - City:BYESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43723-9564
Mailing Address - Country:US
Mailing Address - Phone:740-255-7685
Mailing Address - Fax:
Practice Address - Street 1:9875 ROLLER RD
Practice Address - Street 2:
Practice Address - City:BYESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43723-9564
Practice Address - Country:US
Practice Address - Phone:740-255-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN111341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse