Individual
KEVIN M JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, RN, APNP
Contact information
Practice address
5000 W CHAMBERS ST, MILWAUKEE, WI 53210-1650
(414) 874-4316
(414) 874-4160
Mailing address
972 N GREEN BAY RD, GRAFTON, WI 53024-1527
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4684-33
WI
Other
Enumeration date
11/03/2011
Last updated
11/03/2011
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