Gerhard Heinz Jakubowski, RN , BSN, CFRN
Individual provider Active NPI Emergency Registered Nurse · Polacca, AZ
NPI 1578073805 · NPPES record last updated Sep 29, 2017
Key facts
- NPI
- 1578073805
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Registered Nurse 163WE0003X
- License
- RN104727 (AZ)
- Practice address
- PO Box 4000
Polacca, AZ 86042-4000 - Phone
- (928) 737-6000
- NPI assigned
- Sep 29, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN104727 | AZ | MD | Emergency Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | RN104727 | AZ | Yes |
Addresses
Primary practice location
PO Box 4000
Polacca, AZ 86042-4000
Mailing address
PO Box 4000
Polacca, AZ 86042-4000
Phone (928) 737-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020529 | Medicaid | AZ |
Other providers in Polacca, AZ
- Kay Lynn Honanie
- Hopi Health Care Center
- Hopi Health Care Center
- Jacqueline Hughes
- Walema Ignacio
- Derek Phillip James
- Daniel Jenkins
- Mary Beth Johnson
- Nicole Jojola
- Andrea Lynn Joshevama
All providers in Polacca, AZ · Emergency Registered Nurse in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.