Provider Demographics
NPI:1942383013
Name:JACOBS, LESLEY MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LESLEY
Other - Middle Name:MARIE
Other - Last Name:LAVALAIS-JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1770 W IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1240
Mailing Address - Country:US
Mailing Address - Phone:330-963-4535
Mailing Address - Fax:
Practice Address - Street 1:1770 W IDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-1240
Practice Address - Country:US
Practice Address - Phone:330-963-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN217958163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667556Medicaid