Provider Demographics
NPI:1376866624
Name:BEAUJUIN, JASMINE (RN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BEAUJUIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 CANEY LN
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2618
Mailing Address - Country:US
Mailing Address - Phone:347-238-5629
Mailing Address - Fax:
Practice Address - Street 1:13814 CANEY LN
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2618
Practice Address - Country:US
Practice Address - Phone:347-238-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY614501OtherNYS RN LICENSE