Individual
MS. BERNICE C JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6125 S BROADWAY, LORAIN, OH 44053-3820
(440) 233-8181
(440) 233-8182
Mailing address
PO BOX 901681, CLEVELAND, OH 44190-1681
(440) 233-8181
(440) 233-8182
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN185635
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
NA01928
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2029996
—
OH
Enumeration date
08/30/2005
Last updated
05/05/2011
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