Provider Demographics
NPI:1821417601
Name:GASQUE, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:GASQUE
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 1:932 HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-2762
Mailing Address - Country:US
Mailing Address - Phone:803-496-3324
Mailing Address - Fax:
Practice Address - Street 1:932 HOLLY ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-2762
Practice Address - Country:US
Practice Address - Phone:803-496-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse