Provider Demographics
NPI:1295541316
Name:JACOBS, ROTESHA B
Entity type:Individual
Prefix:
First Name:ROTESHA
Middle Name:B
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18012 LAKE SHORE BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1247
Mailing Address - Country:US
Mailing Address - Phone:216-403-1630
Mailing Address - Fax:
Practice Address - Street 1:18012 LAKE SHORE BLVD APT 203
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1247
Practice Address - Country:US
Practice Address - Phone:216-403-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker