Provider Demographics
NPI:1467919662
Name:ASARE, JENNIFER (RN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:ASARE
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 1:15507 S NORMANDIE AVE # 492
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4013
Mailing Address - Country:US
Mailing Address - Phone:310-925-1331
Mailing Address - Fax:
Practice Address - Street 1:22211 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-4117
Practice Address - Country:US
Practice Address - Phone:310-925-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95058645163WH0200X, 163WA2000X, 163WE0003X, 163WC0200X
CA95058646208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WE0003XNursing Service ProvidersRegistered NurseEmergency