Provider Demographics
NPI:1437912441
Name:MCGILLICK, JASMINE MERCINA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MERCINA
Last Name:MCGILLICK
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 1:10 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1433
Mailing Address - Country:US
Mailing Address - Phone:607-349-8919
Mailing Address - Fax:
Practice Address - Street 1:10 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1433
Practice Address - Country:US
Practice Address - Phone:607-349-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY757754-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse