Provider Demographics
NPI:1467793505
Name:JASTER, LAUREL M (NP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:M
Last Name:JASTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LAUREL
Other - Middle Name:M
Other - Last Name:JASTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2525 DE SALES AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-495-2525
Mailing Address - Fax:423-495-2625
Practice Address - Street 1:2525 DE SALES AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-2525
Practice Address - Fax:423-495-2625
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA716145163W00000X
CA22828363LF0000X
TNAPN0000018264363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse