Individual
SHANDA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, APN, BC-FNP
Contact information
Practice address
4251 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 531-7526
Mailing address
4251 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 531-7526
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
105042
MO
363LF0000X
Family Nurse Practitioner
Primary
105042
MO
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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