Provider Demographics
NPI:1639544091
Name:DAVIS, JASMINE GLORIA (LPN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:GLORIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E MARKET ST
Mailing Address - Street 2:APT 5J
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2041
Mailing Address - Country:US
Mailing Address - Phone:201-241-0780
Mailing Address - Fax:
Practice Address - Street 1:107 E MARKET ST
Practice Address - Street 2:APT 5J
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2041
Practice Address - Country:US
Practice Address - Phone:201-241-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324243-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse