Individual
KARA B JACOBSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2525 CHICAGO AVE S, ATTN CHILDRENS PRIMARY CLINIC MPLS, MINNEAPOLIS, MN 55404
(612) 813-6107
(612) 813-7473
Mailing address
2910 CENTRE POINTE DR, STE 35-121A, ROSEVILLE, MN 55113
(651) 855-2109
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R1213362
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1931525900
—
MN
Enumeration date
08/02/2005
Last updated
07/08/2007
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