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Individual
JACQUELYN JACOBS
Active
Individual
JACQUELYN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103000903
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010191998
—
VA
01
—
181784
ANTHEM BC BS
VA
Enumeration date
05/17/2006
Last updated
11/03/2009
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