Individual
MS. ANNA TERESE JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
60 HAMILTON RD, GALLUP, NM 87301-7310
(715) 305-5424
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
377
MN
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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