Individual
KIMBERLY A JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
347 NORTH SMITH AVENUE, CHILDRENS SPECIALTY CLINIC HEMATOLOGY ONCOLOGY STPL, ST PAUL, MN 55102
(651) 220-6732
(651) 220-6005
Mailing address
2910 CENTRE POINTE DRIVE 35121A, CHILDRENS HEALTH CARE, ROSEVILLE, MN 55113
(651) 855-2327
(651) 855-2310
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R1469844
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
847981000
—
MN
Enumeration date
03/24/2006
Last updated
10/16/2012
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