Jacob, Michelle Veronica

Jacob, Michelle Veronica is an individual health care provider with primary practice located at 4500 Memorial Dr Dept Anesthesiology, Belleville IL 62226-5360. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Jacob, Michelle Veronica can be contacted via phone (800) 862-9980.

Contact Information

Primary practice address
4500 Memorial Dr Dept Anesthesiology Belleville IL 62226-5360
Phone: (800) 862-9980
Fax: (314) 362-7785
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 209011680 Illinois

Profile Details

NPI number 1033548045
LBN Legal business name Jacob, Michelle Veronica
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 11th, 2013
Last updated Nov 15th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033548045 NPPES
Missouri MEDICAID 420022730

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