Individual
KIMBERLY K JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14700 28TH AVE N STE 20, PLYMOUTH, MN 55447-4876
(763) 559-3779
(763) 450-3986
Mailing address
PO BOX 47159, PLYMOUTH, MN 55447-0159
(763) 559-3779
(763) 450-3986
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
66773
WI
207L00000X
Anesthesiology Physician
Primary
78154
MN
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
66773
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851786248
—
WI
Enumeration date
04/01/2015
Last updated
11/10/2024
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