Provider Demographics
NPI:1699413609
Name:NORTON, JACOB ANDREW
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ANDREW
Last Name:NORTON
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 1:1602 FISCHER AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3817
Mailing Address - Country:US
Mailing Address - Phone:707-599-5905
Mailing Address - Fax:
Practice Address - Street 1:1602 FISCHER AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3817
Practice Address - Country:US
Practice Address - Phone:707-599-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator