Provider Demographics
NPI:1639332661
Name:JACOBS, VERNEST L
Entity Type:Individual
Prefix:MISS
First Name:VERNEST
Middle Name:L
Last Name:JACOBS
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:PO 948
Mailing Address - Street 2:203 LOOKOUT
Mailing Address - City:CATLIN
Mailing Address - State:IL
Mailing Address - Zip Code:61817
Mailing Address - Country:US
Mailing Address - Phone:217-427-5365
Mailing Address - Fax:
Practice Address - Street 1:203 LOOKOUT 948
Practice Address - Street 2:
Practice Address - City:CATLIN
Practice Address - State:IL
Practice Address - Zip Code:61817
Practice Address - Country:US
Practice Address - Phone:217-427-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies