Provider Demographics
NPI:1083012538
Name:JASPER, DEANNA LATOYA
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LATOYA
Last Name:JASPER
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 1:11011 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2826
Mailing Address - Country:US
Mailing Address - Phone:763-862-9093
Mailing Address - Fax:763-755-0217
Practice Address - Street 1:11011 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-2826
Practice Address - Country:US
Practice Address - Phone:763-862-9093
Practice Address - Fax:763-755-0217
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN471049469Medicaid