Provider Demographics
NPI:1962645424
Name:JACOBS, REBA WILLIAMS
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:WILLIAMS
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:P.O.BOX 203
Mailing Address - Street 2:15893 N.EDGEMONT DR.
Mailing Address - City:DOLAN SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86441
Mailing Address - Country:US
Mailing Address - Phone:928-671-0709
Mailing Address - Fax:
Practice Address - Street 1:17160 N.MAGNOLIA DR.
Practice Address - Street 2:
Practice Address - City:DOLAN SPRING
Practice Address - State:AZ
Practice Address - Zip Code:86441
Practice Address - Country:US
Practice Address - Phone:928-767-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide