Provider Demographics
NPI:1952425852
Name:JACOBUS, ROSE ELLEN (RN, LMP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ELLEN
Last Name:JACOBUS
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2286 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-8253
Mailing Address - Country:US
Mailing Address - Phone:509-884-6933
Mailing Address - Fax:509-884-5080
Practice Address - Street 1:667 GRANT RD
Practice Address - Street 2:SUITE #3
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7818
Practice Address - Country:US
Practice Address - Phone:509-884-2512
Practice Address - Fax:509-884-5080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004015163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)