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Individual

CAROL ILMA JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1205 NORTH AVE, CLEVELAND, WI 53015-1413
(920) 693-5600
(920) 693-5604
Mailing address
1274 MEADOWBROOK DRIVE, CLEVELAND, WI 53015

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
137
WI

Other

Enumeration date
07/25/2006
Last updated
07/08/2007
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