Individual
LAVONNE JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, CNM
Contact information
Practice address
3208 AMBERWOOD CT, EDMOND, OK 73003-2133
(405) 509-4661
(800) 865-6885
Mailing address
3208 AMBERWOOD CT, EDMOND, OK 73003-2133
(405) 509-4661
(800) 865-6885
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
NMW621
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NMW006210
MEDI-CAL
CA
01
—
R 0101207
OKLAHOMA ADVANCED PRACTICE REGISTERED NURSE LICENSE
OK
01
—
ZZZ37640Z
BLUE SHIELD
CA
Enumeration date
05/19/2008
Last updated
07/08/2013
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