Individual
SANDRA J JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
(575) 396-1454
Mailing address
7711 NE 175TH ST, APT A302, KENMORE, WA 98028-3567
(425) 274-5046
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP30004485
WA
367500000X
Certified Registered Nurse Anesthetist
CRNA00524
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2701JA
INDIVIDUAL BLUE SHIELD
WA
05
—
9612078
—
WA
Enumeration date
02/08/2006
Last updated
11/04/2014
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