Raechel Jacobson

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

100231315 Issued in WI

Practice address

449 S 1St St
Evansville, WI 53536-1394

Phone

(608) 882-4338

NPI assigned

Jun 16, 2020

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 16, 2020.

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1679198600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 HIGHLAND PARK AVE",
            "city": "CLINTON",
            "state": "WI",
            "postal_code": "535259795",
            "telephone_number": "608-302-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "449 S 1ST ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361394",
            "telephone_number": "608-882-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "RAECHEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "100231315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Nicole Halson, APNP
• Cali Hensel, DDS
• Chad Anton Hermanson
• Allison Herrick, PHARMD.
• Jacob Schoenenberger, OD
• Brennen Jaquint, PT, DPT
• Erin Keleny
• Jeremy S Kim, DO
• Kindling Wellness LLC
• Renee Corinne Kinney, LPN

• All providers in Evansville, WI
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.