Provider Demographics
NPI:1558632992
Name:JACOBY, CASEY LYNNE
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNNE
Last Name:JACOBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YOUNGTONG GU MAETAN 2 DONG 1199
Mailing Address - Street 2:WONCHEON SEONGIL APT 202 1011
Mailing Address - City:SUWON SI
Mailing Address - State:GYEONGGI DO
Mailing Address - Zip Code:443 711
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:YOUNGTONG GU MAETAN 2 DONG 1199
Practice Address - Street 2:WONCHEON SEONGIL APT 202 1011
Practice Address - City:SUWON SI
Practice Address - State:GYEONGGI DO
Practice Address - Zip Code:443 711
Practice Address - Country:KR
Practice Address - Phone:8219-150-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula