Provider Demographics
NPI:1245807775
Name:MOORE, JASMINE R
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:R
Last Name:MOORE
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 1:4625 QUIMBY AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1537
Mailing Address - Country:US
Mailing Address - Phone:703-517-6330
Mailing Address - Fax:
Practice Address - Street 1:4625 QUIMBY AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1537
Practice Address - Country:US
Practice Address - Phone:703-517-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program