Provider Demographics
NPI:1255057642
Name:PETERSON, JASMINE CAASIA I
Entity type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:CAASIA
Last Name:PETERSON
Suffix:I
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 1:12908 FERRIS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-5553
Mailing Address - Country:US
Mailing Address - Phone:216-972-1190
Mailing Address - Fax:
Practice Address - Street 1:8745 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-5388
Practice Address - Country:US
Practice Address - Phone:800-275-8777
Practice Address - Fax:216-271-5722
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide