Provider Demographics
NPI:1619465606
Name:WILLIAMS, JASMINE JEANETTE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:JEANETTE
Last Name:WILLIAMS
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 1:5044 BLUE ROSE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2677
Mailing Address - Country:US
Mailing Address - Phone:702-219-1393
Mailing Address - Fax:
Practice Address - Street 1:5044 BLUE ROSE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2677
Practice Address - Country:US
Practice Address - Phone:702-219-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator