Individual
JACOB CONNOR LANSBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-13502
NC
363AS0400X
Surgical Physician Assistant
Primary
0010-13502
NC
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912681867
—
NC
Enumeration date
06/12/2023
Last updated
09/26/2023
Update your record
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