Provider Demographics
NPI:1902479108
Name:JACOBS, ELISE (RN)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 WOODLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2454
Mailing Address - Country:US
Mailing Address - Phone:216-308-2662
Mailing Address - Fax:
Practice Address - Street 1:1444 WOODLAKE BLVD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2454
Practice Address - Country:US
Practice Address - Phone:216-308-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist