Individual
DESHA PERRY JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
4505 SAGES AVE, INDIAN TRAIL, NC 28079-6621
(704) 493-2087
Mailing address
4505 SAGES AVE, INDIAN TRAIL, NC 28079-6621
(704) 493-2087
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
164318
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2092-0582
NATIONAL CERTIFICATION BOARD FOR DIABETIC EDUCATORS
NC
Enumeration date
06/30/2013
Last updated
07/12/2013
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