Provider Demographics
NPI:1518219559
Name:PETWAY, JASMINE SHIRELLE
Entity Type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:SHIRELLE
Last Name:PETWAY
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 1:834 MARJORIE CT SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-6016
Mailing Address - Country:US
Mailing Address - Phone:202-417-4365
Mailing Address - Fax:
Practice Address - Street 1:834 MARJORIE CT SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-6016
Practice Address - Country:US
Practice Address - Phone:202-417-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide