Jacobs, Diana R
Jacobs, Diana R is an individual health care provider with primary practice located at 13111 N Port Washington Rd , Mequon WI 53097-2416. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jacobs, Diana R can be contacted via phone (262) 243-6548.Contact Information
Primary practice address
13111 N Port Washington Rd
Mequon WI 53097-2416
Phone: (262) 243-6548
Fax: (262) 243-7599
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 27996 | Wisconsin |
Profile Details
| NPI number | 1386745487 |
|---|---|
| LBN Legal business name | Jacobs, Diana R |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Jul 21st, 2022 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386745487 | NPPES |
| Wisconsin | MEDICAID | 30045000 |
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