Provider Demographics
NPI:1356957906
Name:JACOBSEN, JULIE ELIZABETH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:81324-4900
Mailing Address - Country:US
Mailing Address - Phone:970-677-2291
Mailing Address - Fax:
Practice Address - Street 1:24151 ROAD S.8
Practice Address - Street 2:
Practice Address - City:DOLORES
Practice Address - State:CO
Practice Address - Zip Code:81323-9135
Practice Address - Country:US
Practice Address - Phone:303-919-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0114961163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice