Individual
CAROLINE N JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, APRN
Contact information
Practice address
4804 NW BETHANY BLVD, STE I-2, #142, PORTLAND, OR 97229
(503) 332-6000
Mailing address
4804 NW BETHANY BLVD., STE I-2, #142, PORTLAND, OR 97229
(503) 332-6000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60167711
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0271524
LABOR & INDUSTRIES
WA
05
—
1306158548
—
WA
Enumeration date
07/03/2010
Last updated
07/21/2022
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