Provider Demographics
NPI:1467134056
Name:JACOBSON, NIKKI LEA (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEA
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:LEA
Other - Last Name:CHEESEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1401
Mailing Address - Country:US
Mailing Address - Phone:320-223-4781
Mailing Address - Fax:
Practice Address - Street 1:403 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1401
Practice Address - Country:US
Practice Address - Phone:320-223-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN525367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife