Provider Demographics
NPI:1679609184
Name:JACOB, JOAN ELLEN (RN)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ELLEN
Last Name:JACOB
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 1:2221 LAKE ROCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9409
Mailing Address - Country:US
Mailing Address - Phone:330-297-9397
Mailing Address - Fax:330-297-7721
Practice Address - Street 1:2221 LAKE ROCKWELL RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9409
Practice Address - Country:US
Practice Address - Phone:330-297-9397
Practice Address - Fax:330-297-7721
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN198052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse