Individual
CAROL ELIZABETH JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-5058
Mailing address
3181 SW SAM JACKSON PARK RD, UHN 73A, PORTLAND, OR 97239-3011
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
200140162RN
OR
363LA2100X
Acute Care Nurse Practitioner
Primary
200150018NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292871
—
OR
Enumeration date
08/02/2006
Last updated
08/15/2007
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