Provider Demographics
NPI:1902483761
Name:JACOB, MINI ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MINI
Middle Name:ELIZABETH
Last Name:JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
Mailing Address - Street 2:1959 NE PACIFIC ST #356560
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6560
Mailing Address - Country:US
Mailing Address - Phone:206-543-6577
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST # 356560
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6560
Practice Address - Country:US
Practice Address - Phone:206-543-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program