Individual
ALICE M JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(307) 634-2273
Mailing address
306 E 18TH ST APT 2, CHEYENNE, WY 82001-4663
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PT852
WY
Other
Enumeration date
12/17/2019
Last updated
12/17/2019
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