Doctor Name: | ELIZABETH MARIE JACOBSEN |
NPI Number: | 1023450145 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.P.M. |
License Number: | 135.000811 |
Business Practice Address: | 215 E 1st St Suite 310 Dixon, IL - 610213166 |
Business Phone Number: | 8152855801 |
Business Fax Number: | 8152855699 |
Mailing Address: | 215 E 1st St, Suite 310 DIXON |
State: | IL |
Postal Code: | 610213166 |
Phone Number: | 8152855801 |
Fax Number: | 8152855699 |
NPI Enumeration Date: | 07/18/2013 |
NPI Last Update Date: | 07/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 135.000811 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |