Provider Demographics
NPI:1700402484
Name:JACOBS, JULIE (RN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 MANNING AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-8419
Mailing Address - Country:US
Mailing Address - Phone:651-283-5116
Mailing Address - Fax:
Practice Address - Street 1:7400 MANNING AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-8419
Practice Address - Country:US
Practice Address - Phone:651-283-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN129243-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN129243-5OtherMINNESOTA BOARD OF NURSING