Provider Demographics
NPI:1447406921
Name:JACOBUS, CAROLINE A (RN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-624-5622
Practice Address - Fax:315-624-5625
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2020-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY408240163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator