Individual
NISHA LASSI JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11850 BLACKFOOT ST NE, SUITE 100, COON RAPIDS, MN 55433-2598
(763) 712-2100
(763) 712-2190
Mailing address
11850 BLACKFOOT ST NW, SUITE 100, COON RAPIDS, MN 55433-2598
(763) 712-2100
(763) 712-2190
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49898
MN
207RH0003X
Hematology & Oncology Physician
Primary
49898
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
958440000
—
MN
Enumeration date
04/06/2007
Last updated
08/24/2016
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