Individual
MARY ANN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
740 E STATE ST, 740 E STATE STREET, SHARON, PA 16146-3328
(724) 983-7310
(724) 983-2797
Mailing address
4135 BOARDMAN CANFIELD RD, SUITE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN234981L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000594284
ANTHEM
OH
05
—
0018937140001
—
PA
01
—
007666ZB29
MEDICARE PTAN
PA
05
—
2313491
—
OH
01
—
P00755667
MEDICARE RAILROAD
PA
Enumeration date
07/05/2006
Last updated
03/22/2019
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