Lynanne Jacob, R.N.

Primary specialty

College Health Registered NurseTaxonomy code 163WC1400X

License

214049 Issued in CA

Practice address

2222 Bancroft Way
Berkeley, CA 94720-4301

Phone

(510) 642-1814

Fax

(510) 643-2997

NPI assigned

Dec 15, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1821367160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 BANCROFT WAY",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947204301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 BANCROFT WAY",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947204301",
            "telephone_number": "510-642-1814",
            "fax_number": "510-643-2997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "LYNANNE",
        "credential": "R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, College Health",
            "state": "CA",
            "license": "214049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Maria Jackson, M.D.
• Samirah Nasiha Jackson
• Shannon Michelle Jackson, MA
• Summer Jackson, LCSW
• Jacob Donnelly, Licensed Clinical Social Worker, Inc.
• Mack Jacob, DDS
• James Harris Jacobs, PH.D.
• Carl H. Jacobsen, O.D.
• Donna Ann Jacobsen, D. O.
• Aaron Robert Jacobson, M.A.

• College Health Registered Nurse in Berkeley, CA
• Providers in Berkeley, CA by specialty
• College Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; 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.