Provider Demographics
NPI:1477870616
Name:JASMIN-JEAN, MARIE CLAUDE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CLAUDE
Last Name:JASMIN-JEAN
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 1:1106 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7923
Mailing Address - Country:US
Mailing Address - Phone:516-653-1764
Mailing Address - Fax:
Practice Address - Street 1:1106 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7923
Practice Address - Country:US
Practice Address - Phone:516-653-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477870616Medicaid