| Doctor Name: | KANUKAYI JACOBSEN |
| NPI Number: | 1609249275 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 11818 Se Mill Plain Blvd 213 Vancouver, WA - 986845089 |
| Business Phone Number: | 3608364386 |
| Business Fax Number: | |
| Mailing Address: | 303 Ne 16th Ave, Apt 106 PORTLAND |
| State: | OR |
| Postal Code: | 972323088 |
| Phone Number: | 5033108581 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2015 |
| NPI Last Update Date: | 11/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |