Individual
MR. RICHARD YNGVE JACOBSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
112 JEFFERSON ST, WEST UNION, IA 52175
(563) 422-3811
Mailing address
112 JEFFERSON ST, WEST UNION, IA 52175-1022
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
101116
IA
367500000X
Certified Registered Nurse Anesthetist
55485
KS
Other
Enumeration date
07/10/2006
Last updated
05/28/2019
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