Provider Demographics
NPI:1437544970
Name:WILLIAMS, JASMINE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WILLIAMS
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 1:2743 W CONGRESS PKWY
Mailing Address - Street 2:UNIT GW
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3485
Mailing Address - Country:US
Mailing Address - Phone:773-766-9008
Mailing Address - Fax:773-696-1170
Practice Address - Street 1:2743 W CONGRESS PKWY
Practice Address - Street 2:UNIT GW
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3485
Practice Address - Country:US
Practice Address - Phone:773-766-9008
Practice Address - Fax:773-696-1170
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041427184163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse