Individual
MR. JACOB GREGORY HUSEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4321 FIR ST, EAST CHICAGO, IN 46312-3049
(219) 703-1764
Mailing address
4321 FIR ST, EAST CHICAGO, IN 46312-3049
(219) 331-9169
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71009696A
IN
Other
Enumeration date
10/21/2019
Last updated
12/07/2020
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