Individual
BETH A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4 MEMORIAL DR STE 230, ALTON, IL 62002-6704
(618) 463-7833
Mailing address
4 MEMORIAL DR STE 230, ALTON, IL 62002-6704
(618) 463-7833
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-013053
IL
363LA2200X
Adult Health Nurse Practitioner
2012038004
MO
Other
Enumeration date
11/08/2012
Last updated
05/15/2023
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