Provider Demographics
NPI:1659079192
Name:JARZYNSKI, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:JARZYNSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15859 E JAMISON DR APT 10312
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4677
Mailing Address - Country:US
Mailing Address - Phone:608-697-9327
Mailing Address - Fax:
Practice Address - Street 1:1750 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-1453
Practice Address - Country:US
Practice Address - Phone:816-654-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program