Individual
MAVIS JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
8055 CORNISH AVE, ELMHURST, NY 11373-3728
(718) 899-6258
Mailing address
18811 SUFFOLK DR, SAINT ALBANS, NY 11412-3008
(646) 523-3801
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
528003-1
NY
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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