Provider Demographics
NPI:1518423466
Name:JAKUBOWSKI, HAILEY ANN (LPN)
Entity type:Individual
Prefix:MISS
First Name:HAILEY
Middle Name:ANN
Last Name:JAKUBOWSKI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12638 PRESBYTERIAN RD
Mailing Address - Street 2:
Mailing Address - City:KNOWLESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14479-9193
Mailing Address - Country:US
Mailing Address - Phone:585-682-1216
Mailing Address - Fax:
Practice Address - Street 1:12638 PRESBYTERIAN RD
Practice Address - Street 2:
Practice Address - City:KNOWLESVILLE
Practice Address - State:NY
Practice Address - Zip Code:14479-9193
Practice Address - Country:US
Practice Address - Phone:585-798-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty