Provider Demographics
NPI:1467748640
Name:JACOBS, JEANNINE N (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:N
Last Name:JACOBS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4325
Mailing Address - Country:US
Mailing Address - Phone:518-588-4343
Mailing Address - Fax:
Practice Address - Street 1:34 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4325
Practice Address - Country:US
Practice Address - Phone:518-588-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN