Provider Demographics
NPI:1649061953
Name:JACOBSON, NORA J (LPN)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:J
Last Name:JACOBSON
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 1:12201 S RICH AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-9718
Mailing Address - Country:US
Mailing Address - Phone:616-900-5240
Mailing Address - Fax:
Practice Address - Street 1:12201 S RICH AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-9718
Practice Address - Country:US
Practice Address - Phone:616-900-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703114113164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse