Provider Demographics
NPI:1265787006
Name:JACOBSEN, JANAE LOUISE (RN, MS, CNP)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:LOUISE
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:RN, MS, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N CAMPUS DR
Mailing Address - Street 2:WELLNESS CENTER, BOX 2818
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57007-0001
Mailing Address - Country:US
Mailing Address - Phone:605-688-4157
Mailing Address - Fax:
Practice Address - Street 1:1440 N CAMPUS DR
Practice Address - Street 2:WELLNESS CENTER, BOX 2818
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57007-0001
Practice Address - Country:US
Practice Address - Phone:605-688-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-CNP CP000719363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner