Individual
JOHN JACOBS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
3236 E GRAND AVE STE D, LARAMIE, WY 82070-5100
(307) 760-8602
(307) 460-9880
Mailing address
3236 E GRAND AVE STE D, LARAMIE, WY 82070-5100
(307) 760-8602
(307) 460-9880
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
34286.1346
WY
363LF0000X
Family Nurse Practitioner
APN.0990808-NP
CO
363LF0000X
Family Nurse Practitioner
RN2259982
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P01679910
—
WY
Enumeration date
11/01/2013
Last updated
11/14/2018
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