Provider Demographics
NPI:1760572580
Name:JACOBSON, ELIZABETH (CRNFA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W EXCHANGE ST
Mailing Address - Street 2:622 METROPOLITAN OBSTETRICS AND GYNECOLOGY PA
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-227-9141
Mailing Address - Fax:651-265-6772
Practice Address - Street 1:17 W EXCHANGE ST
Practice Address - Street 2:622 METROPOLITAN OB AND GYN
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-227-9141
Practice Address - Fax:651-265-6772
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0839349163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant