Provider Demographics
NPI:1962017301
Name:JASTATT, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:JASTATT
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 1:1827 TIFFANY DR NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4180
Mailing Address - Country:US
Mailing Address - Phone:330-314-3336
Mailing Address - Fax:
Practice Address - Street 1:1827 TIFFANY DR NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4180
Practice Address - Country:US
Practice Address - Phone:330-314-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker