Provider Demographics
NPI:1891315289
Name:BASSUE, JAMALJE ROHNQUIST
Entity Type:Individual
Prefix:
First Name:JAMALJE
Middle Name:ROHNQUIST
Last Name:BASSUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NE 53RD ST APT 3110
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1886
Mailing Address - Country:US
Mailing Address - Phone:405-738-6488
Mailing Address - Fax:
Practice Address - Street 1:101 NE 53RD ST APT 3110
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1886
Practice Address - Country:US
Practice Address - Phone:405-738-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program