Provider Demographics
NPI:1326773300
Name:SMITH, JASMINE NICOLE (MBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9181 S ASPEN DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4470
Mailing Address - Country:US
Mailing Address - Phone:414-509-9726
Mailing Address - Fax:
Practice Address - Street 1:9181 S ASPEN DR UNIT 6
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4470
Practice Address - Country:US
Practice Address - Phone:414-628-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker