Individual
DR. LYNNETTE S JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8020 E CENTRAL AVE, SUITE 200, WICHITA, KS 67206-2360
(316) 636-2662
(316) 636-2644
Mailing address
8020 E CENTRAL AVE, SUITE 200, WICHITA, KS 67206-2360
(316) 636-2662
(316) 636-2644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0429210
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100447120B
—
KS
Enumeration date
05/01/2006
Last updated
01/14/2011
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