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Individual

THOMAS JOSEPH JACOBSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2400 UNSER BLVD SE, RIO RANCHO, NM 87124-3392
(505) 253-7878
Mailing address
1808 NW 177TH TER, EDMOND, OK 73012-6931
(405) 696-9015

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
71305
NM
390200000X
Student in an Organized Health Care Education/Training Program
R0126117
OK

Other

Enumeration date
12/08/2022
Last updated
02/17/2023
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