Provider Demographics
NPI:1912023797
Name:JACOBS, YVETTE BROWN
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:BROWN
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 1:3520 GENERAL DEGAULLE DR
Mailing Address - Street 2:SUITE 3023
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6757
Mailing Address - Country:US
Mailing Address - Phone:504-362-4663
Mailing Address - Fax:504-362-4676
Practice Address - Street 1:3520 GENERAL DEGAULLE DR
Practice Address - Street 2:SUITE 3023
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6757
Practice Address - Country:US
Practice Address - Phone:504-362-4663
Practice Address - Fax:504-362-4676
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5076376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1651958Medicaid
LA1651940Medicaid
LA1190012Medicaid