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Individual

LISA JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
268 STILLWATER AVE, BANGOR, ME 04401-3945
(207) 973-7306
(207) 973-6109
Mailing address
21823 E SANDY HILL LN, SOUTH BEND, IN 46628-9518
(574) 807-5145

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R038704
ME

Other

Enumeration date
09/29/2006
Last updated
09/04/2015
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