Individual
KAYLA MARIE JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 793-6550
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
23535830
WI
363L00000X
Nurse Practitioner
Primary
16541
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100309907
—
WI
Enumeration date
10/19/2024
Last updated
03/26/2025
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