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Individual

DR. KIMBERLY JACOBSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
14500 99TH AVE N STE 100, MAPLE GROVE, MN 55369-4738
(763) 898-1000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD60825838
WA
207XX0801X
Orthopaedic Trauma Physician
Primary
MD60825838
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1386945004
WA
Enumeration date
11/11/2010
Last updated
11/10/2021
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