Provider Demographics
NPI:1942457098
Name:FOLGER LATTERELL, JASMINE SABA (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:SABA
Last Name:FOLGER LATTERELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:SABA
Other - Last Name:FOLGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:615 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55320
Mailing Address - Country:US
Mailing Address - Phone:320-558-2293
Mailing Address - Fax:
Practice Address - Street 1:615 NELSON DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:MN
Practice Address - Zip Code:55320
Practice Address - Country:US
Practice Address - Phone:320-558-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1942457098Medicaid
MN080021051Medicare PIN