Provider Demographics
NPI:1831658848
Name:ROUMELL, JASMINE RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENEE
Last Name:ROUMELL
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 1:38 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WYANDANCH
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2324
Mailing Address - Country:US
Mailing Address - Phone:631-505-8927
Mailing Address - Fax:
Practice Address - Street 1:38 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2324
Practice Address - Country:US
Practice Address - Phone:631-505-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319950164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse