Provider Demographics
NPI:1518626183
Name:ANDERSON, JASMINE UNIQUE (PCA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:UNIQUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SIERRA VISTA DR APT C15
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-9369
Mailing Address - Country:US
Mailing Address - Phone:725-216-4203
Mailing Address - Fax:
Practice Address - Street 1:6609 OUIDA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5543
Practice Address - Country:US
Practice Address - Phone:725-216-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health