| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ASHLEY NICOLE JACOBSON | 1104548957 | 2022-09-16 |
Ashley Nicole Jacobson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1104548957. Registration indicates Ashley Nicole Jacobson is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Ashley Nicole Jacobson |
| Practice Office Address | 81 N MARIO CAPECCHI DR SALT LAKE CITY, UT US |
| Practice Office Telephone | 8016621000 |
| Mailing Address | 5770 S 1500 W SALT LAKE CITY, UT 841235216 US |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |